PB Coding Denials Integrity Specialist - Complex Specialties

13245 Enterprise Revenue Cycle - Integrity Operations: Professional Coding DenialsFull timeYes40

Schedule Details/Additional Information:

Will support:

• Denials Integrity for Complex Specialties for this opportunity include Ambulatory Surgical Centers, Anesthesia, Pain Management and Oncology

Schedule:

• Monday - Friday 1st shift 40 hours a week. Flexibility to work between 4:00am to 6:00pm

Certification required:

• Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or
• American Health Information Management Association (AHIMA)
• Specialty Certification preferred

Remote opportunity:

Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY

Pay Range:

$33.05 - $49.60

Major Responsibilities

• Analyze and resolve coding-related PB denials using CPT, HCPCS, ICD-10-CM, and modifiers.
• Identify root causes, patterns, and trends in denial and rejection codes.
• Collaborate with billing, coding, and payer teams to correct, resubmit, and prevent denied claims.
• Conduct chart reviews to validate documentation against billed services.
• Prepare and support appeals by researching payer guidelines, coding standards, and coverage policies.
• Ensure accurate, compliant coding and sequencing aligned with official guidelines and payer requirements.
• Track, document, and report denial resolutions, appeal outcomes, and coding quality issues.
• Support compliance, quality assurance, and revenue integrity initiatives through issue monitoring and escalation resolution.
• Educate clinicians, coders, and staff by sharing findings and supporting targeted training based on denial trends.
• Contribute to operational and strategic initiatives, including denial avoidance strategies, work queue optimization, CARC code mapping, and technology-driven improvements.

Minimum Job Requirements

Education

• Associate degree or equivalent education and experience required.

Certification / Registration / License

• Coding credential required. A Coding Certification from American Health Information Management Association (AHIMA) or
• American Academy of Professional Coders (AAPC) with relevant experience.

Experience

• 4 years of experience in expert-level professional coding or hospital-based coding and experience in revenue cycle processes, health information workflows, and medical record auditing experience

Knowledge / Skills / Abilities

• Advanced knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage decisions, research related restrictions, and ICD-10-PCS/CM, CPT, and HCPCS coding classification systems.
• Advanced knowledge of medical terminology, anatomy, and physiology.
• Advanced ability to identify coding discrepancies and provide recommendations for improvement
• Advanced ability to analyze trends and data and display them in a statistical reporting format.
• Advanced knowledge of care delivery documentation systems and related medical record documents.
• Advanced knowledge of Medicare, Medicaid, and commercial payer coding guidelines.
• Advanced knowledge of Microsoft Office, video and web conferencing, email, and experience with electronic coding and EHR systems or applications.
• Advanced interpersonal and communication (oral and written) skills, including the ability to effectively collaborate with multiple departments.
• Advanced organization and prioritization skills; ability to manage multiple priorities in a stressful, fast-paced work environment.
• Advanced analytical skills, with great attention to detail.
• Self-motivated with initiative and strong sense of ethics.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Strong organizational skills and ability to work independently with limited guidance or direction. Effective critical thinking, creativity, problem solving and decision-making skills.

Physical Requirements and Working Conditions

• Position requires travel which will result in exposure to road and weather hazards.
• Operates the equipment necessary to perform the job.
• Exposed to a normal office environment.

Preferred Job Requirements

Preferred Certification / Registration / License

• Second Specialty credential preferred

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

#REMOTE

#LIn-REMOTE

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

Originally posted on