Coding Denial Resolution Specialist I

Job Description:

We are hiring in the following states:
AR, AZ, CA, CO, CT, FL, GA, HI, IA, IL, ME, MN, MO, NC, NE, NV, OK, PA, SD, TN, TX, VA, WA, WI
This is a remote position. Candidates who meet the minimum qualifications will be required to complete a pre-interview.
Hourly Rate: Up to $26.00/hour based on experience
At Currance, we believe in recognizing the unique skills and experiences that each candidate brings to our team. Our overall compensation package is competitive and is determined by a combination of your experience in the industry and your knowledge of revenue cycle operations. We are committed to offering a rewarding environment that aligns with both individual contributions and our company goals.
Benefits include paid time off, 401(k) plan, health insurance (medical, dental, and vision), life insurance, paid holidays, training and development opportunities, a focus on wellness and support for work-life balance, and more.
Please note that we are looking for people who have hospital billing experience in collections and have some HB billing experience, in high dollar collections, adjustments and denials management.

Job Overview

The Coding Denial Resolution Specialist I plays a vital role in Operations, working remotely and responsible for clearly identifying, investigating, and resolving coding-related denials from payers. This position helps prevent lost reimbursements and supports denial prevention efforts. This role is responsible for timely, accurate, and thorough corrections and appeals for all assigned accounts, identifying the root causes of denials, and ensuring compliance with local, state, and federal regulations, as well as accrediting body guidelines. They are expected to resubmit corrected claims accurately, resolve coding denials effectively, and maximize client reimbursements by collaborating with internal and client teams.

Job Duties and Responsibilities

• 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.

Performance Expectations

• Productivity: Achieve 100% of the project daily goal.
• Quality: Achieve 95% monthly quality assurance score.
• Other expectations: As outlined by the department.

Qualifications

• 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.

Knowledge, Skills, and Abilities

• Understanding of ICD-10 diagnosis and procedure codes, as well as CPT/HCPCS codes.
• Familiarity with regulations related to Healthcare Revenue Cycle administration.
• Skill in investigating medical accounts and resolving claims.
• Ability to validate payments and make informed decisions quickly.
• Capacity to learn and use collaboration and messaging tools effectively.
• Ability to maintain a positive attitude, pleasant demeanor, and act in the best interests of both the organization and the client.
• Competence in researching healthcare revenue cycle rules and regulations.
• Ability to maintain a positive attitude, pleasant demeanor, and act in the best interests of both the organization and the client.
• Professional commitment to the quality and timeliness of work.
• Capacity to achieve results with minimal supervision while balancing multiple priorities.
• Strong organizational skills with the ability to manage high-volume workloads and meet deadlines.