Coding Denial and Resolution Specialist (FT- 1.0 FTE, Day Shift, Remote)

This position can be remote. Please review the approved remote states below.

Remote Work Approved States:

Arizona

Florida

Georgia

Idaho

Iowa

South Dakota

Texas

South Carolina

Wisconsin

North Carolina

Michigan

*If your state is not listed, you must relocate to Montana or one of the approved states above to be eligible for this position.

Position Summary:

Responsible for reviewing and resolving post-billed coding-related denials and rejections for hospital and medical group claims to support accurate reimbursement and denial prevention. Applies expertise in International Classification of Diseases, Tenth Revision (ICD-10), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) to validate denial rationale, determine root cause, and recommend corrective actions. Prepares, submits, and tracks payer appeals and reconsiderations within required timeframes while maintaining complete documentation. Collaborates with coding, billing, clinical, compliance, and information systems partners to reduce avoidable denials and provide education on coding best practices.

Qualifications:

Required

• Associate’s Degree in Health Information Management, Business, or related field, or equivalent combination of education and experience may be considered.
• Current coding certification: CCA, CPC, CCS, CCS-P, CPMA, RHIA, or RHIT.
• Three (3) years’ experience in advanced hospital and professional (practice) coding.
• Knowledge of ICD-10 diagnosis and procedure coding, CPT, HCPCS, modifiers, and coding guidelines.
• Proficiency with Microsoft Office applications, including advanced Excel, Word, and PowerPoint skills.

Preferred

• Bachelor’s Degree in Health Information Management, Business, or related field.
• Two (2) years’ experience in coding denial management, appeals, or related denial resolution work.
• Certified Professional Medical Auditor (CPMA).
• Experience with Epic and 3M.
• Experience using payer portals, electronic work queues, and denial/appeals tracking tools.

Essential Job Functions: In addition to the essential functions of the job listed below, employees must have on-time completion of all required education as assigned per DNV requirements, Bozeman Health policy, and other registry requirements.

• Reviews and triages post-billed coding denials, rejections, and coding-related billing edits for assigned professional and/or facility claim inventory.
• Validates denial rationale using remittance advice/Explanation of Benefits (EOB), payer policies, coding guidelines, and applicable regulations.
• Performs medical record review to confirm documentation support, code selection, modifier usage, and charge accuracy; identifies and initiates required corrections.
• Coordinates charge and coding corrections and supports rebilling actions in accordance with established workflows and department standards.
• Drafts, submits, and tracks first-level and second-level appeals/reconsiderations, ensuring compliance with payer requirements and timely filing deadlines.
• Documents actions taken, supporting evidence, communications, and outcomes in the denial management system to maintain a complete audit trail.
• Analyzes denial trends and root-cause categories; prepares routine and ad hoc reports and communicates findings to stakeholders.
• Partners with coding, billing, clinical staff, patient access, information systems, and compliance to resolve complex denials and implement denial prevention strategies.
• Develops and delivers education and presentations to providers and staff on denial drivers and coding best practices, including National Correct Coding Initiative (NCCI) edits.
• Maintains working knowledge of payer medical review policies and regulatory guidance, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).

Knowledge, Skills and Abilities

• Demonstrates sound judgment, patience, and maintains a professional demeanor at all times
• Exercises tact, discretion, sensitivity, and maintains confidentiality
• Performs essential job functions successfully in a busy and stressful environment
• Learns current and new computer applications and office equipment utilized at Bozeman Health
• Strong interpersonal, verbal, and written communication skills
• Analyzes, organizes, and prioritizes work while meeting multiple deadlines

Schedule Requirements

• This role requires regular and sustained attendance.
• The position may necessitate working beyond a standard 40-hour workweek, including weekends and after-hours shifts.
• On-call work may be required to respond promptly to organizational, patient, or employee needs.

Physical Requirements

• Lifting (Rarely – 30 pounds): Exerting force and/or using a negligible amount of force to lift, carry, push, pull, or otherwise move objects or people.
• Sit (Continuously): Maintaining a sitting posture for extended periods may include adjusting body position to prevent discomfort or strain.
• Stand (Occasionally): Maintaining a standing posture for extended periods may include adjusting body position to prevent discomfort or strain.
• Walk (Occasionally): Walking and moving around within the work area requires good balance and coordination.
• Climb (Rarely): Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like using feet and legs; may also use hands and arms.
• Twist/Bend/Stoop/Kneel (Occasionally): Twisting, bending, stooping, and kneeling require flexibility and a wide range of motion in the spine and joints.
• Reach Above Shoulder Level (Occasionally): Lifting, carrying, pushing, or pulling objects as necessary above the shoulder, requiring strength and stability.
• Push/Pull (Occasionally): Using the upper extremities to press or exert force against something with steady force to thrust forward, downward, or outward.
• Fine-Finger Movements (Continuously): Picking, pinching, typing, or otherwise working primarily with fingers rather than using the whole hand as in handling.
• Vision (Continuously): Close visual acuity to prepare and analyze data and figures and to read computer screens, printed materials, and handwritten materials.
• Cognitive Skills (Continuously): Learn new tasks, remember processes, maintain focus, complete tasks independently, and make timely decisions in the context of a workflow.
• Exposures (Rarely):Bloodborne pathogens, such as blood, bodily fluids, or tissues. Radiation in settings where medical imaging procedures are performed. Various chemicals and medications are used in healthcare settings. Job tasks may involve handling cleaning products, disinfectants, and other substances. Infectious diseases due to contact with patients in areas that may have contagious illnesses.

*Frequency Key: Continuously (100% - 67% of the time), Repeatedly (66% - 33% of the time), Occasionally (32% - 4% of the time), Rarely (3% - 1% of the time), Never (0%).

The above statements are intended to describe the general nature and level of work being performed by people assigned to the job classification. They are not to be construed as a contract of any type nor an exhaustive list of all job duties performed by individuals so classified.