Coding Denials Specialist

The Medical College Of Wisconsin

426d • Remote

About The Position

The Coding Denials Specialist at the Medical College of Wisconsin (MCW) is responsible for managing coding denials and ensuring accurate claim submissions. This role involves researching payer denials, conducting comprehensive reviews of claims, writing and submitting appeals, and collaborating with various teams to minimize avoidable denials. The position is fully remote and requires expertise in coding and reimbursement processes.

Requirements

• High school diploma or equivalent experience.
• Five years of experience in a healthcare setting, specifically in coding and/or reimbursement follow-up.
• Certification as a Certified Professional Coder (CCS-P, CPC, CCA) or health information management credential (RHIT or RHIA).

Nice To Haves

• Bachelor's degree in business, healthcare management, or related fields.
• Five or more years of coding and/or reimbursement follow-up experience in large, multispecialty group practices or academic medical centers.

Responsibilities

• Research payer denials related to coding, documentation, referral, pre-authorization, notifications, medical necessity, non-covered services, and billing.
• Conduct comprehensive reviews of claim denials and associated medical records to determine necessary actions.
• Write and submit professionally written appeals based on clinical documentation and payer policies.
• Submit detailed, customized appeals to payers in accordance with guidelines and compliance policies.
• Collaborate with the prior authorization team to obtain retro-authorizations in response to denials.
• Identify denial patterns and escalate issues to management for follow-up and resolution.
• Make recommendations for improvements to work queues and claim edits to reduce denials.
• Review payer communications to identify risks related to reimbursement and escalate issues as needed.
• Identify opportunities for process improvement and participate in initiatives.

Benefits

• Outstanding Healthcare Coverage including Health, Vision, and Dental.
• 403B Retirement Package.
• Competitive Vacation and Paid Holidays.
• Tuition Reimbursement.
• Paid Parental Leave.
• Pet Insurance.
• On-campus Fitness Facility with onsite classes.
• Discounted rates on select cell phone plans and local fitness facilities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Educational Services
• Education Level: High school or GED