CPC Denials Escalation Analyst

Essential Responsibilities

• Master claim denials and claims processing to support denial prevention strategies and drive claim resolution to payment.
• Review coding-related denials for potential correction and resubmission.
• Work assigned high-level A/R projects and complex claim investigations.
• Maintain adherence to quality and productivity standards established by the organization and industry guidelines.
• Follow up on escalated or project-related claims, working no fewer than 65–70 claims per day.
• Identify denial and payer trends and communicate findings to AR management.
• Conduct follow-up with Medicare and Commercial insurance payers on escalated claims.
• Assist in identifying the need for payer policy updates or process changes to support regulatory compliance and claim payment.
• Participate in special projects as assigned.

Essential Skills

• Extremely detail-oriented.
• Comprehend all issues and articulate them to any person involved needed to assist in their complete resolution.
• Advanced analytical and reporting skills.
• Basic understanding of rudimentary medical terminology.
• Excellent judgment and decision-making.
• Problem-solving and organizational skills.
• Reliability, accuracy, and efficiency when dealing with patients or third-party payors.
• Excellent verbal and written communication skills.
• Ability to use good judgment in highly emotional and demanding situations.
• Excellent oral and written communication skills.
• Ability to manage multiple tasks with ease and efficiency.
• To work independently with minimal supervision and be result-oriented.
• Effective interpersonal skills, including the ability to promote teamwork.
• Strong problem-solving skills.
• Ability to ensure a high level of customer satisfaction, including employees, patients, physicians, and external stakeholders.
• Maintains confidentiality of sensitive information.

Education and Experience Required

• CPC, CPB, or AHIMA associate's degree.
• 5+ years Revenue Cycle Management experience.
• Strong understanding of CPT, HCPCS, accounts receivable, and charge capture workflows.
• Experience with Athena, Epic, or comparable PM/EHR systems.

Pay & Schedule

We offer competitive base salary, generous benefits, including Medical, Dental, Vision, Life Insurance, Voluntary, Time-Off Benefits, EAP, 401K and Commuter Benefits. Monday-Friday 8:30am-5:00pm.