Denial Management Specialist – Orthopedic Services

Healthcare Coding And Consulting Svcs•Fort Myers, FL

1d•Remote

About The Position

Healthcare Coding & Consulting Services (HCCS) is seeking an experienced Denial Management Specialist with a strong background in both medical billing and medical coding. This is a fully remote, full-time position supporting orthopedic revenue cycle and denial management operations. The ideal candidate understands the full revenue cycle, including coding, claim submission, payer follow-up, denial resolution, and appeals. Although this role will initially focus on orthopedic denials and ERISA appeals, candidates must be flexible and comfortable supporting billing, coding, accounts receivable, claims follow-up, and denial management needs across multiple specialties. At HCCS, all team members are direct-hire W-2 employees. We offer stable, long-term employment, comprehensive benefits, supportive leadership, and opportunities for professional growth. We proudly keep all coding and revenue cycle services within the United States.

Requirements

Minimum of three years of professional healthcare revenue cycle experience.
Professional experience in both medical billing and medical coding required.
Experience with denial management, claims resolution, accounts receivable follow-up, appeals, or payer correspondence.
Experience with Epic, Athena, NextGen, eClinicalWorks, or comparable healthcare systems.
Knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI edits, medical necessity requirements, and payer reimbursement policies.
Experience working with commercial insurance, Medicare, Medicaid, self-funded health plans, payer portals, and claim follow-up workflows.
Ability to review medical records, claims, EOBs, remittance advice, and payer correspondence to identify billing and coding issues.
Strong written communication skills with experience preparing professional appeal letters.
Strong analytical, organizational, and problem-solving abilities.
Ability to independently manage a high-volume workload and meet payer deadlines.
Proficiency in Microsoft Excel, Word, and Outlook.

Nice To Haves

CPC, CCS, CPMA, or similar certification preferred, but not required.
CPB certification preferred.

Responsibilities

Supporting orthopedic revenue cycle and denial management operations.
Understanding the full revenue cycle, including coding, claim submission, payer follow-up, denial resolution, and appeals.
Focusing on orthopedic denials and ERISA appeals.
Supporting billing, coding, accounts receivable, claims follow-up, and denial management needs across multiple specialties.
Reviewing medical records, claims, EOBs, remittance advice, and payer correspondence to identify billing and coding issues.
Preparing professional appeal letters.
Managing a high-volume workload and meeting payer deadlines.