Denials Specialist
Summary
Reviews medical claims to correct coding errors, resolve denials, and recover underpaid revenue using CPT, ICD-10, and payer policies.
UASI is seeking an experienced Denials Specialists with coding expertise to join our team! The Denials Specialist will be responsible for reviewing documentation to ensure accuracy of diagnoses and procedure codes and resolving claim denials related to coding, billing, and payer policy compliance. This role focuses on identifying coding errors, modifier issues, bundling conflicts, and billing rule discrepancies to recover underpaid or denied revenue and prevent future denials.
Responsibilities:
- Review the provider's documentation to ensure all diagnoses and procedure codes were reported accurately.
- Research CMS LCD, NCD, NCCI Edit Policy, CPT Assistant, HCPCS Coding Clinics, payer guidelines, etc.
- Complete charge corrections and update claims when coding corrections are needed.
- Identify claims that do not support billed CPT codes and take action as needed.
- Identify and resolve claims requiring adjustments by updating the billed E/M and procedure codes with a non-billable charge code.
- Identify trends and provide feedback to prevent future denials.
Qualifications
- Professional coding certification such as CPC, CCS, CIC, or COC and 1 year of experience in a coding-related denials management role.
- Experience with complex surgical specialties and interventional radiology (IR) is a plus but not required.
- Familiarity with Athena is preferred.
- Experience with a variety of denial types including medical necessity, timely filing, incorrect modifier usage, and unbundling of procedure codes.
- Strong working knowledge of
- CPT®, HCPCS, ICD-10-CM/PCS
- Modifiers and NCCI edits
- Medicare and commercial payer billing rules
- Strong attention to detail and strong analytical skills.
- Knowledge of payer contracts and reimbursement methodologies.
UASI provides a supportive environment that encourages professional development and enables each employee to achieve their individual goals. We offer a competitive pay and excellent benefit package.
Don’t pass on this great career opportunity! Interested candidates can apply online at .