E/M Denial Research Specialist

CU Medicine•Aurora, CO

23d•Remote

About The Position

University of Colorado Medicine (CU Medicine) is the region’s largest and most comprehensive multi-specialty physician group practice. The CU Medicine team delivers business operations, revenue cycle and administrative services to support the patients of over 4,000 University of Colorado School of Medicine physicians and advanced practice providers. These providers bring their unparalleled expertise at the forefront of medicine to deliver trusted, compassionate health care services at primary and specialty care clinics as well as facilities operated by affiliate hospitals of the University of Colorado. We are seeking a highly motivated E/M Denial Research Specialist to join our Accounts Receivable Resolution team. This job can be performed 100% remotely, and out of state candidates will be considered. The E/M Denial Research Specialist is responsible for reviewing, analyzing, and resolving Evaluation and Management (E/M) related coding denials to support accurate reimbursement and revenue integrity. This role applies established coding guidelines and documentation standards to determine the appropriate resolution, including write-offs, claim corrections, or payer reconsideration requests. The position also identifies denial trends and collaborates with leadership to proactively address recurring billing or payer issues.

Requirements

Certified Professional Coder (CPC) or Certified Evaluation and Management Coder (CEMC) credential required.
Bachelor’s degree in a related field or three to five (3–5) years of experience in medical practice billing required, including experience working with claim denials, appeals, and related follow-up activities.
Strong working knowledge of medical terminology and human anatomy required.
Demonstrated understanding of Evaluation and Management (E/M) coding guidelines, payer policies, and claims denial appeal processes.
Ability to analyze denial root causes and apply appropriate resolution strategies, including claim corrections, reconsiderations, and write-offs.
Experience interpreting and applying payer contract language and reimbursement policies.
Intermediate proficiency with PC software and billing or revenue cycle management systems required.
Advanced verbal and written communication skills, including the ability to prepare professional correspondence to payers and internal stakeholders.
Strong analytical, organizational, and problem-solving skills with the ability to manage multiple accounts while meeting productivity and accuracy standards.
Effective interpersonal and collaboration skills to work with physicians, coding teams, revenue cycle staff, and leadership.

Responsibilities

Research and analyze E/M coding denials to determine billing accuracy and compliance with coding guidelines.
Recommend claim write-offs when E/M services are determined to be non-billable or not separately reimbursable.
Identify and recommend necessary corrections to CPT levels, modifiers, or diagnosis codes when supported by clinical documentation.
Draft and submit payer reconsiderations or appeals when E/M services are appropriately coded and supported by documentation.
Monitor and report denial patterns, trends, and payer behavior to the Supervisor or Manager.
Prioritize and manage a high volume of denial accounts while maintaining accuracy and quality standards.
Maintain an in-depth understanding of current E/M coding guidelines, payer policies, and industry best practices.
Meet established productivity standards, with a minimum production expectation of 50 accounts per day.
Reviewing denial documentation and claim details.
Evaluating clinical documentation against E/M coding guidelines and payer policies.
Determining the appropriate resolution pathway:
Write-off
Claim correction and rebill
Dispute or reconsideration submission