Coding Denials Resolution Specialist

Healthrise

Responsible for reviewing coding-related denials for healthcare operations. Appeals denials based on coding expertise and promotes best practices within the team.

Posted 7/17/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in professional and hospital outpatient coding, appeals management, and compliance with healthcare billing standards. Holds relevant coding credentials and possesses strong analytical skills to identify and resolve coding denials effectively.

Highest-signal resume keywords

Professional Coding ExpertiseMedical Claims ProcessingRegistered Health Information Administrator (RHIA)Certified Professional Coder (CPC)National Correct Coding Initiative (NCCI) Experience

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Diagnostic CodingProcedural CodingDRG AssignmentOutpatient Coding GuidelinesHealthcare Billing Compliance

Soft Skills

Collaborative LeadershipAnalytical Problem Solving

Certifications & Qualifications

Registered Health Information Technician (RHIT)Certified Coding Specialist (CCS)Certified Professional Medical Auditor (CPMA)

Industry Keywords

Healthcare Financial ServicesMulti-Site EnvironmentCoding Denials ResolutionPatient Health Record ContentFinancial Counseling

About the role

Key responsibilities & impact

Responsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and judgment within the Hospital and/or Medical Group partner revenue operations.
Serves as part of a team of coding denials resolution specialists responsible for identifying and determining root causes of denials.
Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers.
Promotes departmental awareness of coding best practices.

Requirements

What you’ll need

High school diploma or Associate degree in Accounting, Business Administration, or related field, and a minimum of four (4) years of experience within a hospital or clinic environment, health insurance company, managed care organization, or other healthcare financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service activities; or an equivalent combination of education and experience.
Experience in a complex, multi-site environment preferred.
Must possess comprehensive knowledge of professional/physician diagnostic and procedural coding, as typically obtained through a coding certificate program, and at least one (1) year of physician/professional and hospital outpatient coding experience, or a minimum of two (2) years of relevant hospital inpatient coding experience including DRG assignment.
Must hold one of the following credentials: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC). Certified Professional Medical Auditor (CPMA) will also be considered.
Must have experience with National Correct Coding Initiative edits (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding guidelines for official coding and reporting.
Possesses detailed understanding of principles, methods, and techniques related to compliant healthcare billing/collections.
Demonstrates expertise in medical terminology, disease processes, patient health record content, and the medical record coding process.
Must be comfortable operating in a collaborative, shared leadership environment. Previous experience working with Global Partner vendors is preferred.

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Healthrise Website LinkedIn All Job Openings 51 - 200 employees ⚕️ Healthcare Insurance ☁️ SaaS Healthcare Insurance
Consulting
SaaS Healthrise is a company dedicated to providing comprehensive healthcare solutions, focusing on revenue cycle management, electronic health record (EHR) services, and strategic consulting. With over a decade of experience, Healthrise assists health systems nationwide in achieving operational and financial success through tailored strategies. Their team of experts partners with healthcare organizations to tackle complex operational challenges and enhance efficiency, ensuring both patient and financial outcomes are optimized. Coding Denials Resolution Specialist Job not on LinkedIn 🔥 27 minutes ago 🇺🇸 United States – Remote ⏰ Full Time 🟡 Mid-level 🟠 Senior 🏥 Medical Billing and Coding 🦅 H1B Visa Sponsor Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Responsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and judgment within the Hospital and/or Medical Group partner revenue operations.
Serves as part of a team of coding denials resolution specialists responsible for identifying and determining root causes of denials.
Responsible for leveraging coding knowledge and standard procedures to track appeals through first, second, and subsequent levels, and ensuring timely filing of appeals as required by payers.
Promotes departmental awareness of coding best practices. 🎯 Requirements
High school diploma or Associate degree in Accounting, Business Administration, or related field, and a minimum of four (4) years of experience within a hospital or clinic environment, health insurance company, managed care organization, or other healthcare financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service activities; or an equivalent combination of education and experience.
Experience in a complex, multi-site environment preferred.
Must possess comprehensive knowledge of professional/physician diagnostic and procedural coding, as typically obtained through a coding certificate program, and at least one (1) year of physician/professional and hospital outpatient coding experience, or a minimum of two (2) years of relevant hospital inpatient coding experience including DRG assignment.
Must hold one of the following credentials: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC). Certified Professional Medical Auditor (CPMA) will also be considered.
Must have experience with National Correct Coding Initiative edits (NCCI), National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and Outpatient coding guidelines for official coding and reporting.
Possesses detailed understanding of principles, methods, and techniques related to compliant healthcare billing/collections.
Demonstrates expertise in medical terminology, disease processes, patient health record content, and the medical record coding process.
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