Position Overview: The Senior Coding & Denials Specialist is a subject matter expert responsible for investigating, resolving and preventing coding- and billing-related claim denials.

This position combines advanced medical coding knowledge with strong revenue-cycle, payer-policy, claims and appeals expertise. The Senior Coding & Denials Specialist will analyze denied and underpaid claims, determine the root cause, research applicable coding and payer requirements, develop and submit appropriate appeals or corrected claims, and work collaboratively with Coding, Billing, Clinical Operations and providers to prevent recurring denials.

The ideal candidate is a critical thinker and problem solver who can move beyond simply resolving an individual denial to identifying why the denial occurred, what process contributed to it, and what needs to change to prevent it from happening again.

Key Responsibilities:

• Review patient records and accurately assign appropriate ICD-10-CM, CPT, and HCPCS codes for diagnoses, procedures, and treatments
• Apply advanced knowledge of ICD-10-CM, CPT and HCPCS coding to investigate coding-related denials
• Review medical records and clinical documentation to determine whether the documentation supports billed services
• Identify coding, modifier, bundling, medical necessity, documentation, authorization and claim-submission issues contributing to denials
• Research CMS requirements, NCCI edits, MUEs, Medicare and Medicaid requirements, and commercial payer policies as applicable
• Evaluate payer-specific reimbursement policies and determine the appropriate claim resolution strategy
• Provide coding guidance for complex claims and denial scenarios
• Collaborate with providers and clinical staff when additional documentation or clarification is required
• Maintain up-to-date knowledge of coding standards, medical terminology, relevant regulatory requirements, and internal MVC policies

Minimum Qualifications:

• Advanced knowledge of ICD-10, CPT, and HCPCS coding systems, medical terminology, anatomy and physiology, and healthcare CMS/payer specific documentation requirements
• Strong understanding of Medicare, Medicaid and commercial payer requirements
• Demonstrated experience researching and resolving medical claims denials
• Demonstrated experience preparing and submitting claim appeals and/or reconsiderations
• Strong understanding of EOBs/ERAs, claim adjustments, corrected claims and payer correspondence
• Strong analytical, investigative and problem-solving skills
• Demonstrated computer literacy and ability to efficiently navigate Electronic Medical Records (EMR) systems
• Ability to work independently, unsupervised, and manage time appropriately
• Excellent verbal and written communication abilities

Required Certifications and Experience

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or equivalent certification required
• Minimum of four years of medical coding experience (multispecialty or vascular coding preferred)
• Minimum of 2 years of hands-on denial management, claims resolution and/or appeals experience preferred
• Successfully complete and pass a coding assessment
• Previous experience with GE Centricity/Athena EMR preferred

Preferred Qualifications

• Vascular, vein, interventional radiology, surgery or other procedural specialty experience
• Experience with medical necessity, authorization and documentation-related denials
• Experience performing denial trend analysis and root-cause analysis
• Experience developing denial-prevention strategies
• Experience communicating with payer representatives
• Experience with claims analytics and revenue-cycle reporting
• Advanced Excel skills, including pivot tables, filtering, lookups and data analysis

Benefits to Support Your Wellbeing & Lifestyle

Full-time team members at Metro Vein Centers are eligible for:

• Medical, Dental, and Vision Insurance
• 401(k) with Company Match
• Paid Time Off (PTO) + Paid Company Holidays
• Company-Paid Life Insurance
• Short-Term Disability Insurance
• Employee Assistance Program (EAP)
• Career Growth & Development Opportunities