Pn Cert Prof Coding Denial Specialist

Cook Children's Health Plan

Remote, TX, US
Fully remote
Complex coding denials resolution
Coding-related claims edits
Payer communication and appeals
Cook Children's Health Plan is seeking a Certified Professional Coding Denial Specialist to review and resolve complex coding denials for healthcare providers. The role requires extensive experience in medical coding, particularly with ICD and CPT codes, along with strong communication skills to interact with payers and defend code assignments

Job Summary

  • The Certified Professional Coding Denial Specialist is responsible for reviewing and determining the root cause of complex coding denials for all providers employed by Cook Children’s Physicians Network.
  • The specialist will analyze and perform appropriate actions for timely completion of special projects, utilizing their deep understanding of coding and classification software and the electronic health record (EHR) system.
  • Cook Children's is an equal opportunity employer offering equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class.

Matching Summary

Match Score: 85

Cook Children's Health Plan is seeking a Certified Professional Coding Denial Specialist to review and resolve complex coding denials for healthcare providers. The role requires extensive experience in medical coding, particularly with ICD and CPT codes, along with strong communication skills to interact with payers and defend code assignments.

Skills & Requirements

Must-have

  • complex coding denials resolution
  • coding-related claims edits
  • payer communication and appeals
  • proficiency in Microsoft Excel
  • knowledge of ICD and CPT code sets
  • use of electronic health record system

Nice-to-have

  • professional interpersonal skills
  • effective communication skills
  • experience with coding and classification software

Key Requirements

  • Current coding certification through AAPC or AHIMA
  • 4-5 years relevant healthcare experience
  • At least 3 years dedicated coding experience
  • Working knowledge of ICD and CPT code sets

Work Rights

Not specified

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