Coding Denial and Appeals Specialist

The Coding Denial and Appeals Specialist plays a vital role in the operations and activities of a centralized denial recovery team, ensuring that process/workflows and data meet regulatory/payer requirements and policies. This role is responsible for reviewing and resolving clinical/medical necessity denials related to outpatient professional/facility services by evaluating and rectifying coding errors and ensuring compliance with healthcare regulations. This role corrects CPT/HCPCS coding discrepancies to ensure accurate and compliant billing and reimbursement, and collaborates with and assists internal stakeholders to support code accuracy on post-billed accounts and post payment audits. This position requires strong coding expertise, analytical skills, and a deep understanding of healthcare reimbursement processes, and will partner with revenue cycle leaders to use data/trends to inform prevention, reduce preventable denial inventory, and maximize recovery goals/targets.

This is a remote position, but employees must reside in Minnesota, Wisconsin, Iowa, North Dakota, or South Dakota, and have a reliable internet connection and a quiet place to work free from interruptions.

Work Schedule:

• Monday-Friday, 7:30 a.m.-4:00 p.m. 

Required Qualifications:

• Graduate from an associate or bachelor’s degree program in health information, completion of a coding specialist program OR successful completion of AHIMA or AAPC coding credential exam.
• Three years of experience in outpatient and/or facility coding.
• One of the following:
  • Certified Professional Coder (CPC) certification.
  • Clinical Coding Specialist (CCS) and registration with the American Health Information Management Association.
  • Associate degree in Health Information Technology and registration with the American Health Information Management Association as a RHIT or RHIA.
• Strong knowledge of ICD-10/PCS, CPT, and HCPCS coding guidelines, rules, and regulations.
• Experience with Epic Denial workflows and work queue management, and proficiency in Epic and coding software.
• Reside in Minnesota, Wisconsin, Iowa, North Dakota, or South Dakota, and have a reliable internet connection and a quiet place to work free from interruptions.

Preferred Qualifications:

• Five years of professional and outpatient/facility coding experience.
• Healthcare Financial Management Association (HFMA) Certified Revenue Cycle Representative (CRCR) certification.
• Experience with large commercial payers and contracts.

Additional Information: 

This is a non-union 1.0 FTE (80 hours per pay period) day shift position working remotely in Minnesota, Wisconsin, Iowa, North Dakota, or South Dakota. The full salary range for this position is $55,161.60-$82,742.40 annually, based on experience and internal equity. This position is exempt under the Fair Labor Standards Act, and is eligible for benefits. Our benefits include medical and dental insurance (which begin on day one of employment), 401k with match, disability insurance, fertility benefits, tuition reimbursement, educational reimbursement toward continuing education, and we are a qualified non-profit employer under the federal Public Service Loan Forgiveness program. We offer an onsite employee fitness center and an onsite employee clinic to make it more convenient for our staff to get the care they need, and have a Center for Employee Resilience that provides support and evidence-based practices to bring relief and build resiliency. Regions is also proud to be a Yellow Ribbon Company.

At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits Designed to Support Your Total Health
As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.