PB Coding Denials Integrity Specialist - Complex Specialties

Department:13245 Enterprise Revenue Cycle - Integrity Operations: Professional Coding DenialsStatus:Full timeBenefits Eligible:YesHours Per Week: 40Schedule 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, WYPay Range:$33.05 - $49.60Major 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 EducationAssociate 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. Experience4 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 care