Coding Denials Specialist

Catholic Health•Melville, NY

2d•Onsite

About The Position

The Coding Denial and Appeal Specialist is responsible for managing coding-related claim denials and ensuring escalation for timely and accurate appeals to payers. This role requires in-depth knowledge of medical coding, payer policies, and denial management processes. The specialist will analyze denied claims, identify root causes, and collaborate with coders, physicians, and billing teams to ensure proper documentation and maximize reimbursement.

Requirements

High School Diploma or GED (required)
CPC, COC, or CIC (AAPC) or CCS, CCS-P (AHIMA) certification required.
2+ years of experience in medical coding and/or denial management
Strong knowledge of CPT, ICD-10-CM, HCPCS coding, and medical terminology
Familiarity with payer-specific guidelines and medical necessity policies
Experience using EHR and billing systems (e.g., Epic, Cerner, Meditech, etc.)
Experience working in a hospital, physician group, or health system environment
Familiarity with Medicare, Medicaid, and commercial payer appeal processes
Excellent written communication and persuasive writing skills
Detail-oriented with strong analytical and problem-solving abilities
Ability to manage time and meet strict deadlines for appeals
Proficient in Microsoft Office Suite (especially Word and Excel)
Ability to work independently and as part of a cross-functional team
Knowledge of healthcare reimbursement methodologies (e.g., DRG, APC, RBRVS)

Nice To Haves

Associate’s or Bachelor’s Degree in Health Information Management, Healthcare Administration, or related field (preferred)
Previous experience using denial management software or appeal automation tools

Responsibilities

Review and analyze denied medical claims related to coding (CPT, ICD-10, HCPCS, modifiers, etc.).
Determine the root cause of coding denials and identify trends or systemic issues.
Communicate with payers, providers, and internal teams to resolve coding-related denials.
Stay current with federal and state coding regulations, payer policies, and industry best practices.
Collaborate with coding, billing, and compliance teams to ensure coding accuracy and prevent future denials.
Generate and report denial metrics to leadership as required.