Coding Denials Specialist

Medsuite Inc

Coding Denials Specialist managing claim edits and rejections for Ventra Health, a healthcare solutions provider. Investigating and resolving health plan denials to ensure proper coding and billing compliance.

Posted 7/2/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in physician medical billing, particularly in coding denial management and appeals generation. Proficient in healthcare reimbursement guidelines and coding standards, with strong organizational and communication skills.

Highest-signal resume keywords

AAPC CertificationAHIMA CertificationICD-10-CM CodingCPT CodingHealthcare Reimbursement Guidelines

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical BillingCoding Denial ManagementClaims ResearchAppeals GenerationCoding Accuracy Validation

Soft Skills

Organizational SkillsAnalytical SkillsTime ManagementInterpersonal CommunicationWritten Communication

Tools & Technologies

ExcelBilling SystemsWorkflow Tools

Certifications & Qualifications

AAPC CertificationAHIMA Certification

Industry Keywords

Health InsurancePhysician Billing PoliciesAHA Official Coding GuidelinesCMS Directives

About the role

Key responsibilities & impact

Process accounts that meet coding denial management criteria including rejections and bundling issues.
Resolve work queues according to prescribed priority.
Validate denial reasons and ensures coding is accurate.
Generate appeals based on dispute reasons and contract terms.
Follow specific payer guidelines for appeals submission.
Escalate exhausted appeal efforts for resolution.
Maintain working knowledge of workflow, systems, and tools used in the department.

Requirements

What you’ll need

High school diploma or equivalent.
One to three years’ experience in physician medical billing with emphasis on research and claim denials.
Current AAPC or AHIMA certification required.
Knowledge of health insurance, including coding.
Thorough knowledge of physician billing policies and procedures.
Thorough knowledge of healthcare reimbursement guidelines.
Knowledge of AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding.
Computer literate, working knowledge of Excel helpful.
Good organizational and analytical skills.
Ability to work independently.
Strong oral, written, and interpersonal communication skills.
Strong time management and organizational skills.

Benefits

Comp & perks

Ventra performance-based incentive plan
Referral Bonus