PB Coding Denials Integrity Specialist - Complex Specialties

American Addiction Centers • Oak Brook, IL

1d • $33 - $50 • Remote

About The Position

This full-time role as a PB Coding Denials Integrity Specialist - Complex Specialties will support Denials Integrity for Complex Specialties, including Ambulatory Surgical Centers, Anesthesia, Pain Management, and Oncology. The position operates Monday through Friday, with a 40-hour work week, offering flexibility between 4:00 am and 6:00 pm. Advocate Health may approve remote work for candidates residing in specific registered states. The role involves analyzing and resolving coding-related denials, identifying root causes, collaborating with various teams to prevent denied claims, conducting chart reviews, preparing appeals, and ensuring accurate and compliant coding.

Requirements

• Associate degree or equivalent education and experience required.
• Coding credential required: A Coding Certification from American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) with relevant experience.
• 4 years of experience in expert-level professional coding or hospital-based coding.
• Experience in revenue cycle processes, health information workflows, and medical record auditing experience.
• Advanced knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage decisions, research related restrictions, and ICD-10-PCS/CM, CPT, and HCPCS coding classification systems.
• Advanced knowledge of medical terminology, anatomy, and physiology.
• Advanced ability to identify coding discrepancies and provide recommendations for improvement.
• Advanced ability to analyze trends and data and display them in a statistical reporting format.
• Advanced knowledge of care delivery documentation systems and related medical record documents.
• Advanced knowledge of Medicare, Medicaid, and commercial payer coding guidelines.
• Advanced knowledge of Microsoft Office, video and web conferencing, email, and experience with electronic coding and EHR systems or applications.
• Advanced interpersonal and communication (oral and written) skills, including the ability to effectively collaborate with multiple departments.
• Advanced organization and prioritization skills; ability to manage multiple priorities in a stressful, fast-paced work environment.
• Advanced analytical skills, with great attention to detail.
• Self-motivated with initiative and strong sense of ethics.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Strong organizational skills and ability to work independently with limited guidance or direction.
• Effective critical thinking, creativity, problem solving and decision-making skills.

Nice To Haves

• Second Specialty credential preferred.

Responsibilities

• Analyze and resolve coding-related PB denials using CPT, HCPCS, ICD-10-CM, and modifiers.
• Identify root causes, patterns, and trends in denial and rejection codes.
• Collaborate with billing, coding, and payer teams to correct, resubmit, and prevent denied claims.
• Conduct chart reviews to validate documentation against billed services.
• Prepare and support appeals by researching payer guidelines, coding standards, and coverage policies.
• Ensure accurate, compliant coding and sequencing aligned with official guidelines and payer requirements.
• Track, document, and report denial resolutions, appeal outcomes, and coding quality issues.
• Support compliance, quality assurance, and revenue integrity initiatives through issue monitoring and escalation resolution.
• Educate clinicians, coders, and staff by sharing findings and supporting targeted training based on denial trends.
• Contribute to operational and strategic initiatives, including denial avoidance strategies, work queue optimization, CARC code mapping, and technology-driven improvements.

Benefits

• Comprehensive suite of Total Rewards: benefits and well-being programs
• Competitive compensation
• Generous retirement offerings
• Programs that invest in your career development
• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance
• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree