Denial Management Specialist – Remote

About the role

The Denial Management Specialist is responsible for preventing claim denials, reviewing coding accuracy, and handling appeal processes. The role involves investigating denied claims, correcting coding issues, and collaborating with providers and insurers to ensure timely reimbursement.

Key responsibilities

• Follow up on denied claims from commercial and contracted payers, focusing on coding‑related denials.
• Assign and sequence ICD‑10‑CM and CPT‑4 codes, review physician documentation for accuracy, and correct coding issues per Medicare and AMA guidelines.
• Investigate denied claims, determine appropriate resubmission actions, and coordinate with providers, insurance representatives, and internal billing teams.
• Identify coding trends that increase denial volumes, report to management, and support staff training initiatives.
• Maintain HIPAA compliance, participate in QA/QI activities, and stay updated on payer requirements and regulatory changes.

Required profile

• High School Diploma or GED required; CPC, CPCH, and/or CCS‑P certification required.
• Minimum 2 years billing/accounts receivable experience in a physician practice, 2 years in an FQHC, and 3 years physician coding experience in a multi‑specialty setting.
• Strong knowledge of ICD‑10‑CM and CPT‑4 coding rules and third‑party payer requirements.
• Excellent analytical and communication skills, ability to work under pressure, and commitment to confidentiality.

Required skills

• 3M Encoder and/or Encoder Pro
• Microsoft Excel and Microsoft Office suite
• Electronic Health Record (EHR) systems
• Practice Management systems
• EDI/claims processing systems