Surgical Appeals & Coding Specialist
The Surgical Appeals & Coding Specialist (Denial Specialist) is primarily responsible for resolving all insurance claim denials for assigned specialty departments to enhance revenues for CU Medicine providers. The individual in this position will generate effective written appeals to carriers using well-researched logic. Utilize a multitude of resources to ensure correct appeal processes are followed. Account investigation may be quite extensive and complex. Denial Specialists are independently accountable for the denial resolution for their assigned divisions.
Duties and responsibilities include but are not limited to the following:
- Appeal denials through coding review, contract review, medical record review and carrier interaction.
- Demonstrate a high level of expertise in the management of complicated denied claims.
- Deploy analytical approach to resolve denials and recognize trends/patterns in order to proactively resolve recurring issues.
- Communicate identified denial patterns to management.
- Prioritize and process large volume of denials and maintain high quality of work.
- Serve as an escalation point for unresolved denial issues.
- Inform team members of payer policy changes.
- Assist in training new employees as assigned.
- Collaborate on special projects as needed.
Requires 3-5 years experience in medical practice billing with exposure to working with denials, appeals, insurance collections and related follow-up; bachelor’s degree in a related field is strongly preferred. Must have ICD-10 and CPT coding assessment skills, CPC certification is preferred. Intermediate PC software experience required. Advanced verbal and written communication skills are essential. Must demonstrate a solid understanding and ability to apply contract language in conjunction with a comprehensive understanding of claims denial appeal logic.
All applications MUST be submitted via our website.
CU Medicine is dedicated to ensuring a safe and secure environment for our staff and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees prior to their employment. Additionally, drug and health screenings may be required for some positions. We are an equal opportunity employer.
CU Medicine supports a Tobacco Free Workplace Environment which prohibits smoking and the use of tobacco products on CU Medicine property, Anschutz Medical Campus and adjacent business locations.
- Pay Type Hourly
- Required Education High School
- University of Colorado Medicine, AURORA, Colorado, United States of America