What are the responsibilities and job description for the Coding Denials Specialist position at Advanced Urology?
Coding Denials Specialist
Job Title – Position Description: Coding and Coding Denials Specialist
Reports to: Coding Supervisor MISSION
We are seeking a detail-oriented and knowledgeable Medical Coder with experience in claims scrubbing and denial management to join our Revenue Cycle team. The ideal candidate will be responsible for accurate CPT/ICD-10 coding, ensuring claims are clean and compliant before submission, and investigating and resolving denials from payers. This role plays a key part in optimizing reimbursement and reducing payment delays.
OUTCOMES
- Code medical procedures and diagnoses using CPT, ICD-10, and HCPCS codes based on provider documentation.
- Review and scrub claims for accuracy, completeness, and compliance with payer policies before submission.
- Identify and correct coding errors, mismatched modifiers, or billing inconsistencies that may lead to denials.
- Analyze claim denials and rejections, determine root causes, and coordinate appeals or corrections.
- Collaborate with providers, billing staff, and payers to resolve documentation or coding discrepancies.
- Keep current with coding regulations, payer guidelines, and compliance updates (Medicare, Medicaid, commercial insurers).
- Maintain accurate records of coding decisions, appeals, and resolution timelines.
- Assist in process improvements to reduce denial rates and enhance claim acceptance.
COMPETENCIES
Job Related Competencies:
- Action Oriented: Taking on new opportunities and tough challenges with a sense of urgency, high energy, and enthusiasm.
- Manages Ambiguity: Operating efficiently, even when things are not certain, or the way forward is not clear.
- Manages Complexity: Making sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
- Decision Quality: Making good and timely decisions that keep the organizations moving forward
- Global Perspective: Taking a broad view and approaching issues, using a global lens.
- Resourcefulness: Securing and deploying resources effectively and efficiently.
Cultural Competencies:
Advanced Values:
- People
- Collaborates: Building partnerships and working collaboratively with others to meet shared objectives
- Heart
- Patient Focus: Building strong patient relationships and delivering patient centric solutions
- Service
- Instills Trust: Gaining the confidence and trust of others through honesty, integrity, and authenticity
- Excellence
- Cultivates Innovation: Creating new and better ways for the organization to be successful
Behaviors:
- Being Resilient:
- Rebounding from setback and adversity when facing difficult situations
- Self-Development:
- Actively seeking new ways to grow and be challenged using both formal and informal development challenges
- Optimizes Work Processes:
- Knowing the most effective and efficient processes to get things done, with a focus on continuous improvement
- Professional Communication:
- Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences, while maintaining a professional appearance and tone
QUALIFICATIONS
Basic Qualifications:
Education:
- Certified Professional Coder (CPC) or equivalent credential (e.g., CCS, CCA, RHIT) – required.
- High School Diploma or GED
Previous Job Relevant Work Experience:
- Experience with claim scrubbing tools or clearinghouse platforms (e.g., Trizetto, Waystar, Availity, Change Healthcare).
- Working knowledge of denial codes (CARC/RARC), payer rules, and appeal processes.
- Proficient with EHR and billing systems (eClinicalWorks)
- Strong attention to detail, organizational skills, and ability to meet deadlines.
- Excellent communication and problem-solving skills.
- 2 years of medical coding experience, preferably in urology specialty Previous experience in Urology Billing and Coding
