Are you an experienced Denial Management Specialist, Medical Coder, or Revenue Cycle Professional looking to make an impact in healthcare reimbursement? We are seeking a detail-oriented professional with expertise in medical coding, claims appeals, denial resolution, ICD-10, CPT coding, and insurance reimbursement.
In this role, you will investigate denied claims, correct coding issues, submit appeals, and collaborate with providers and billing teams to maximize reimbursement and reduce payment delays. This is an excellent opportunity for a coding professional who thrives in a fast-paced healthcare environment and enjoys solving complex billing challenges
Requirements and Qualifications Education
High School Diploma or GED required
Experience
Minimum 2 years of medical billing and accounts receivable experience within a physician practice
Minimum 2 years of experience in a Federally Qualified Health Center (FQHC) environment preferred
Minimum 3 years of physician coding experience in a multi-specialty healthcare setting
Experience with denial management, appeals processing, claims correction, and reimbursement recovery
Certifications
CPC (Certified Professional Coder), CPCH, CCS-P, or equivalent coding certification required
Ability to maintain annual certification requirements
Technical Skills
Working knowledge of:
ICD-10-CM diagnosis coding
CPT coding and documentation guidelines
Medicare regulations and AMA coding standards
Commercial insurance and third-party payer requirements
Electronic Health Records (EHR) systems
Practice Management Systems
Claims management and Electronic Data Interchange (EDI) platforms
Strong Microsoft Office skills, including Excel, Word, and Outlook
Responsibilities
Review, investigate, and resolve denied claims from commercial, government, and contracted payers
Analyze medical records to ensure accurate ICD-10 and CPT code assignment and sequencing
Correct coding errors and resubmit claims to reduce reimbursement delays
Process claim appeals and follow denials through resolution
Perform validation and follow-up activities on denials received through EDI systems
Collaborate with providers, insurance representatives, charge posters, and collections teams to gather supporting documentation
Identify coding and denial trends impacting reimbursement and escalate findings to leadership
Serve as a subject matter expert for coding-related denial management activities
Conduct retrospective audits of patient accounts and update demographic information as needed
Resolve routine coding issues and recommend training opportunities for providers and staff
Stay current on federal, state, Medicare, Medicaid, and payer regulations affecting reimbursement
Support special projects, staff education, and revenue cycle improvement initiatives
Maintain compliance with HIPAA, organizational policies, and all applicable regulations
Participate in quality assurance and performance improvement programs
Utilize EHR and practice management systems to support daily operations
Equal Opportunity Employer / Disabled / Protected Veterans
The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf
The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.
AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf
We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
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