Pn Cert Prof Coding Denial Specialist

Cook Children's Health Plan

Remote, TX, US
Fully remote
Complex coding denial resolution
Payer appeal defense strategies
Cms ama aapc guideline application
The specialist is responsible for reviewing and determining the root cause of complex coding denials for all providers employed by Cook Children's Physicians Network

Job Summary

  • The specialist is responsible for reviewing and determining the root cause of complex coding denials for all providers employed by Cook Children's Physicians Network.
  • This role requires actively communicating effectively with payers to defend code assignment and successfully appealing coding-related denials using CMS, AMA, and AAPC guidelines.
  • Cook Children's is a not-for-profit organization recognized for outstanding efforts in pediatric healthcare with over 60 locations throughout Texas.

Matching Summary

The specialist is responsible for reviewing and determining the root cause of complex coding denials for all providers employed by Cook Children's Physicians Network.

Skills & Requirements

Must-have

  • Complex coding denial resolution
  • Payer appeal defense strategies
  • CMS AMA AAPC guideline application
  • Electronic health record system proficiency
  • Microsoft Excel advanced skills

Nice-to-have

  • Strong interpersonal communication skills
  • Deep understanding of reimbursement policies
  • Experience with special projects

Key Requirements

  • High school degree or equivalent
  • 4-5 years relevant healthcare experience
  • 3 years dedicated coding experience
  • Current AAPC or AHIMA certification
  • Proficiency in ICD and CPT code sets

Work Rights

Not specified

Tailored Resume

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