CPC Denials Escalation Analyst

Allied Digestive Health•West Long Branch, NJ

19h•$27 - $31

About The Position

This position requires strong expertise in coding guidelines, payer policy, denials management, and claims processing. The CPC Denials Escalation Analyst will serve as a subject-matter expert on denied-claim escalations, contribute to denial-prevention strategies, perform chart reviews, and ensure claims are properly adjudicated for payment. The role supports complex A/R projects, denial coding reviews, and compliance audits while maintaining productivity and quality standards aligned with regulatory and organizational requirements.

Requirements

Extremely detail-oriented.
Ability to comprehend all issues and articulate them to any person involved(s) needed to assist in their complete resolution.
Advanced analytical and reporting skills
Basic understanding of rudimentary medical terminology
Excellent judgment and decision-making
Problem-solving and organizational skills
Reliability, Accuracy, and Efficiency when dealing with patients or third-party payors
Excellent verbal and written communication skills
Ability to use good judgment in highly emotional and demanding situations
Ability to react to frequent changes in duties and volume of work
Ability to manage multiple tasks with ease and efficiency
Ability to work independently with minimal supervision and be result-oriented
Effective interpersonal skills, including the ability to promote teamwork
Strong problem-solving skills
Ability to ensure a high level of customer satisfaction, including employees, patients, physicians, and external stakeholders
Maintains confidentiality of sensitive information
Broad knowledge of health care business office practices and principles
CPC, CPB, or AHIMA associate's degree
5+ years Revenue Cycle Management experience
Strong understanding of CPT, HCPCS, accounts receivable, and charge capture workflows
Experience with Athena, Epic, or comparable PM/EHR systems

Responsibilities

Master claim denials and claims processing to support denial prevention strategies and drive claim resolution to payment.
Review coding-related denials for potential correction and resubmission.
Work assigned high-level A/R projects and complex claim investigations.
Maintain adherence to quality and productivity standards established by the organization and industry guidelines.
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 AR management.
Conduct follow-up with Medicare and Commercial insurance payers on escalated claims.
Assist in identifying the need for payer policy updates or process changes to support regulatory compliance and claim payment.
Participates in special projects as assigned.
Any other duties as assigned.