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Denial Resolution Specialist
Location
Arizona + 19 moreAll locations: Arizona | California | Colorado | Florida | Illinois | Iowa | Montana | Nebraska | Nevada | New Jersey | North Carolina | Oklahoma | Missouri | Pennsylvania | South Dakota | Tennessee | Texas | Virginia | Washington | Wisconsin
Posted
4 days ago
Salary
$21 - $24 / hour
Seniority
Senior
Job Description
Denial Resolution Specialist
Currance
• Execute tasks focused on revenue generation through account resolution for any company client. • Review documentation to support or contest payer coding decisions for multiple facilities. • Prepare clear, concise, and well-supported appeals where applicable, using all available documentation, coding guidelines, and regulatory references to defend billed claims and secure reimbursement on insurance accounts receivable. • Investigate the root causes of denials and downgrades, as needed. • Provide targeted training on coding practices to Currance team members, promoting accuracy, compliance, and efficiency in resolving coding-related issues. • Participate in daily shift briefings and contribute actively. • Resubmit corrected claims according to Federal, State, and payer-mandated guidelines. • Research, analyze, and correct claim errors and rejections to ensure accurate resubmission and to avoid payer denials due to preventable errors. • Escalate problematic accounts, recurring issues, or trends to Supervisor and recommend education or denial prevention measures to the client. • Stay current on payer updates, process changes, and coding guidelines to maintain compliance with Federal, State, and payer requirements. • Meet productivity standards while maintaining quality output. • Communicate payer-specific issues to the team and management for timely resolution. • Engage in continuous learning to remain up to date on coding and payer policies.
Job Requirements
- High school diploma or equivalent (GED) required.
- Associate or bachelor’s degree in healthcare management, Health Information Management/Technology (HIM/HIT) preferred.
- Current/active CCS or CPC certification required
- Minimum of 3 years’ experience resolving payer denials and/or conducting coding audits.
- At least 3 years’ experience in medical claim payments, follow-up, and appealing denials, with proven success resolving complex, high-value claims.
- Advanced knowledge of ICD-10, CPT/HCPCS, NCCI edits, DRG/APC assignment, payer policies, and reimbursement regulations.
- Strong negotiation, research, written communication, and problem-solving skills, with the ability defend coding-related positions.
- Experience correcting and resubmitting denied claims due to coding issues, including modifiers, revenue codes, bundling, and NPI discrepancies.
- Ability to research regulatory references (CMS, Medicaid, LCD/NCD guidelines) and apply them to appeals.
- Demonstrated ability to analyze denial trends and recommend process or coding improvements.
- Familiarity with compliance standards (OIG, CMS, HIPAA) related to coding and billing.
- Experience using EHR/EMR systems such as Meditech, Epic, Cerner, Allscripts, Nextgen, or similar platforms for billing and account resolution.
- Ability to collaborate effectively with other coders, clinicians, and account resolution specialists to resolve complex coding and reimbursement issues.
- Proficiency in Microsoft Office Suite, Teams, and various desktop applications.
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