Denials Coder
About The Position
The Denials Coder supports the revenue cycle by resolving outstanding insurance balances and complex coding denials. The role researches denial reasons, reviews medical records, and prepares supported appeals for commercial and government health insurance payers to help ensure accurate reimbursement and reduce revenue leakage. The position uses knowledge of ICD-10 and CPT coding to compare documentation with billed services and make adjustments to diagnosis codes, modifiers, and place-of-service information. The Denials Coder manages active work queues, collaborates with providers to correct claim errors, and communicates with payer representatives. Responsibilities also include resubmitting claims electronically and identifying recurring denial trends that may inform proactive staff training, while maintaining compliant and efficient billing processes. The successful candidate has coding experience and a foundation in medical insurance and reimbursement methodologies. The role calls for attention to detail, critical thinking, troubleshooting skills, clear professional communication, comfort with automated coding and billing systems, the ability to prioritize under pressure, and a commitment to data integrity and regulatory compliance.
Requirements
- At least one year of coding experience.
- A strong foundation in medical insurance and reimbursement methodologies.
- Knowledge of ICD-10 and CPT coding.
- Detail orientation and critical-thinking ability.
- Ability to troubleshoot complex billing issues and communicate clearly and professionally.
- Comfort working with automated coding and billing systems.
- Ability to prioritize tasks under pressure.
- Commitment to data integrity and regulatory compliance.
Nice To Haves
- High school graduate or GED and 1+ years of coding experience upon hire.
- Associate-level education in a related field and insurance follow-up experience upon hire.
- Completion of college-level courses in medical terminology, anatomy and physiology, disease processes, and pharmacology upon hire.
- Completion of an ICD-10 or CPT coding course upon hire.
- One of the following upon hire: Certified Professional Coder, Certified Coding Associate, Cardiology Coding, Certified Coding Specialist, or Registered Health Information Technician.
Responsibilities
- Research denial reasons and resolve outstanding insurance balances and complex coding denials.
- Review medical records and compare documentation against billed services.
- Prepare and submit supported appeals to commercial and government health insurance payers.
- Adjust diagnosis codes, modifiers, and place-of-service information as needed.
- Manage active work queues and collaborate with providers to correct claim errors.
- Communicate with payer representatives.
- Resubmit claims electronically.
- Identify recurring denial trends and conduct proactive staff training.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
