PB Coding Denials Integrity Specialist - Complex Specialties

Department:

13245 Enterprise Revenue Cycle - Integrity Operations: Professional Coding Denials Status:

Full time Benefits Eligible:

Yes Hou rs Per Week:

40 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 ind