Coding Denial and Resolution Specialist (FT- 1.0 FTE, Day Shift, Remote)

Bozeman Health

1d•Remote

About The Position

Responsible for reviewing and resolving post-billed coding-related denials and rejections for hospital and medical group claims to support accurate reimbursement and denial prevention. Applies expertise in International Classification of Diseases, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) to validate denial rationale, determine root cause, and recommend corrective actions. Prepares, submits, and tracks payer appeals and reconsiderations within required timeframes while maintaining complete documentation. Collaborates with coding, billing, clinical, compliance, and information systems partners to reduce avoidable denials and provide education on coding best practices.

Requirements

Associate’s Degree in Health Information Management, Business, or related field, or equivalent combination of education and experience may be considered.
Current coding certification: CCA, CPC, CCS, CCS-P, CPMA, RHIA, or RHIT.
Three (3) years’ experience in advanced hospital and professional (practice) coding.
Knowledge of ICD-10 diagnosis and procedure coding, CPT, HCPCS, modifiers, and coding guidelines.
Proficiency with Microsoft Office applications, including advanced Excel, Word, and PowerPoint skills.

Nice To Haves

Bachelor’s Degree in Health Information Management, Business, or related field.
Two (2) years’ experience in coding denial management, appeals, or related denial resolution work.
Certified Professional Medical Auditor (CPMA).
Experience with Epic and 3M.
Experience using payer portals, electronic work queues, and denial/appeals tracking tools.

Responsibilities

Reviews and triages post-billed coding denials, rejections, and coding-related billing edits for assigned professional and/or facility claim inventory.
Validates denial rationale using remittance advice/Explanation of Benefits (EOB), payer policies, coding guidelines, and applicable regulations.
Performs medical record review to confirm documentation support, code selection, modifier usage, and charge accuracy; identifies and initiates required corrections.
Coordinates charge and coding corrections and supports rebilling actions in accordance with established workflows and department standards.
Drafts, submits, and tracks first-level and second-level appeals/reconsiderations, ensuring compliance with payer requirements and timely filing deadlines.
Documents actions taken, supporting evidence, communications, and outcomes in the denial management system to maintain a complete audit trail.
Analyzes denial trends and root-cause categories; prepares routine and ad hoc reports and communicates findings to stakeholders.
Partners with coding, billing, clinical staff, patient access, information systems, and compliance to resolve complex denials and implement denial prevention strategies.
Develops and delivers education and presentations to providers and staff on denial drivers and coding best practices, including National Correct Coding Initiative (NCCI) edits.
Maintains working knowledge of payer medical review policies and regulatory guidance, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).