Senior Coding & Denials Specialist

Position Overview

The Senior Coding & Denials Specialist is a subject matter expert responsible for investigating, resolving and preventing coding- and billing-related claim denials. This position combines advanced medical coding knowledge with strong revenue-cycle, payer-policy, claims and appeals expertise.

Key Responsibilities

• Review patient records and accurately assign appropriate ICD-10-CM, CPT, and HCPCS codes for diagnoses, procedures, and treatments.
• Apply advanced knowledge of ICD-10-CM, CPT and HCPCS coding to investigate coding-related denials.
• Review medical records and clinical documentation to determine whether the documentation supports billed services.
• Identify coding, modifier, bundling, medical necessity, documentation, authorization and claim-submission issues contributing to denials.
• Research CMS requirements, NCCI edits, MUEs, Medicare and Medicaid requirements, and commercial payer policies as applicable.
• Evaluate payer-specific reimbursement policies and determine the appropriate claim resolution strategy.
• Provide coding guidance for complex claims and denial scenarios.
• Collaborate with providers and clinical staff when additional documentation or clarification is required.
• Maintain up-to-date knowledge of coding standards, medical terminology, relevant regulatory requirements, and internal MVC policies.

Minimum Qualifications

• Advanced knowledge of ICD-10, CPT, and HCPCS coding systems, medical terminology, anatomy and physiology, and healthcare CMS/payer specific documentation requirements.
• Strong understanding of Medicare, Medicaid and commercial payer requirements.
• Demonstrated experience researching and resolving medical claims denials.
• Demonstrated experience preparing and submitting claim appeals and/or reconsiderations.
• Strong understanding of EOBs/ERAs, claim adjustments, corrected claims and payer correspondence.
• Strong analytical, investigative and problem-solving skills.
• Demonstrated computer literacy and ability to efficiently navigate Electronic Medical Records (EMR) systems.
• Ability to work independently, unsupervised, and manage time appropriately.
• Excellent verbal and written communication abilities.

Required Certifications and Experience

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or equivalent certification required.
• Minimum of four years of medical coding experience (multispecialty or vascular coding preferred).
• Minimum of 2 years of hands-on denial management, claims resolution and/or appeals experience preferred.
• Successfully complete and pass a coding assessment.

Preferred Qualifications

• Vascular, vein, interventional radiology, surgery or other procedural specialty experience.
• Experience with medical necessity, authorization and documentation-related denials.
• Experience performing denial trend analysis and root-cause analysis.
• Experience developing denial-prevention strategies.
• Experience communicating with payer representatives.
• Experience with claims analytics and revenue-cycle reporting.
• Advanced Excel skills, including pivot tables, filtering, lookups and data analysis.