Claims A/R and Denial Analyst Escalations – CPC Lead

Allied Digestive Health•West Long Branch, NJ

6d•$85,000 - $95,000•Onsite

About The Position

The Claims CPC A/R and Denial Analyst Escalations Lead serves as a subject-matter expert on denied-claim escalations and supports denial-prevention strategies, chart reviews, and appropriate claim adjudication for payment. The role supports complex accounts receivable projects, denial coding reviews, and compliance audits while meeting organizational and industry quality, productivity, regulatory, and operational requirements. The position is based at the Central Business Office in West Long Branch, New Jersey, and follows a Monday–Friday schedule from 8:30 a.m. to 5:00 p.m.

Requirements

CPC, CPB, or an AHIMA associate degree.
At least 5 years of revenue cycle management experience.
Strong understanding of CPT, HCPCS, and charge capture workflows.
Experience with Athena, Epic, or comparable practice management/electronic health record systems.
Extremely detail-oriented.
Ability to comprehend issues and clearly articulate them to the people needed to help resolve them.

Responsibilities

Serve as the subject-matter expert for escalated claim denials from vendors and internal revenue cycle management teams.
Apply expertise in claim denials and claims processing to support denial-prevention strategies and resolve claims through payment.
Review coding-related denials for possible correction and resubmission.
Work on assigned high-level accounts receivable projects and complex claim investigations.
Meet organizational and industry quality and productivity standards.
Follow up on escalated or project-related claims, working no fewer than 65–70 claims per day.
Identify denial and payer trends and communicate findings to accounts receivable management and senior leadership.
Follow up with Medicare and commercial insurance payers on escalated claims.
Perform coding, billing, and documentation compliance audits within established timelines.
Help identify when payer policy updates or process changes are needed to support regulatory compliance and claim payment.
Prepare reports summarizing audit findings and recommendations for operational improvement.
Participate in special projects as assigned.
Perform other duties as assigned.