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Denial Management Specialist – Orthopedic Services
HCCS - Healthcare Coding & Consulting ServicesDenial Management Specialist managing orthopedic revenue cycle and denial management operations remotely for HCCS. Requires experience in medical billing and coding with comprehensive benefits offered.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare revenue cycle management, including medical billing, coding, denial management, and appeals processes. Proficient in utilizing healthcare systems and tools to optimize claims resolution and ensure compliance with payer policies.
Highest-signal resume keywords
Healthcare Revenue Cycle ManagementMedical Billing and CodingDenial ManagementCPT, HCPCS, ICD-10-CM KnowledgeEpic, Athena, NextGen Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical BillingMedical CodingDenial ManagementClaims ResolutionAccounts Receivable Follow-UpAppeals ProcessPayer CorrespondenceCPT KnowledgeICD-10-CM KnowledgeHCPCS Knowledge
Soft Skills
Strong Written CommunicationAnalytical AbilitiesOrganizational SkillsProblem-Solving AbilitiesTime Management
Tools & Technologies
EpicAthenaNextGenEClinicalWorksMicrosoft ExcelMicrosoft WordMicrosoft Outlook
Certifications & Qualifications
CPCCCSCPMACPB
Industry Keywords
Revenue CycleDenial Management OperationsPayer PoliciesCommercial InsuranceMedicareMedicaidSelf-Funded Health PlansClaim Follow-Up WorkflowsMedical Necessity RequirementsNCCI Edits
About the role
Key responsibilities & impact- Support orthopedic revenue cycle and denial management operations
- Understand the full revenue cycle, including coding, claim submission, payer follow-up, denial resolution, and appeals
- Initially focus on orthopedic denials and ERISA appeals
- Support billing, coding, accounts receivable, claims follow-up, and denial management needs across multiple specialties
Requirements
What you’ll need- CPC, CCS, CPMA, or similar certification preferred, but not required
- CPB certification preferred
- Minimum of three years of professional healthcare revenue cycle experience
- Professional experience in both medical billing and medical coding required
- Experience with denial management, claims resolution, accounts receivable follow-up, appeals, or payer correspondence
- Experience with Epic, Athena, NextGen, eClinicalWorks, or comparable healthcare systems
- Knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI edits, medical necessity requirements, and payer reimbursement policies
- Experience working with commercial insurance, Medicare, Medicaid, self-funded health plans, payer portals, and claim follow-up workflows
- Ability to review medical records, claims, EOBs, remittance advice, and payer correspondence to identify billing and coding issues
- Strong written communication skills with experience preparing professional appeal letters
- Strong analytical, organizational, and problem-solving abilities
- Ability to independently manage a high-volume workload and meet payer deadlines
- Proficiency in Microsoft Excel, Word, and Outlook.
Benefits
Comp & perks- Comprehensive benefits
- Supportive leadership
- Opportunities for professional growth
- Stable, long-term employment