Qureos Mentor

Allied Digestive Health

<div><div><div><div><div><p><b>Summary:</b></p><p>
This position requires strong expertise in coding guidelines, payer policy, denials management, and claims processing. The CPC Denials Escalation Analyst will serve as a subject-matter expert on denied-claim escalations, contribute to denial-prevention strategies, perform chart reviews, and ensure claims are properly adjudicated for payment. The role supports complex A/R projects, denial coding reviews, and compliance audits while maintaining productivity and quality standards aligned with regulatory and organizational requirements.</p><p></p><p><b><br>
Essential Responsibilities:</b></p><p>
The responsibilities of the CPC Denials Escalation Analyst will include:</p><ul><li>Master claim denials and claims processing to support denial prevention strategies and drive claim resolution to payment.</li><li>Review coding-related denials for potential correction and resubmission.</li><li>Work assigned high-level A/R projects and complex claim investigations.</li><li>Maintain adherence to quality and productivity standards established by the organization and industry guidelines.</li><li>Follow up on escalated or project-related claims, working no fewer than 65&ndash;70 claims per day.</li><li>Identify denial and payer trends and communicate findings to AR management.</li><li>Conduct follow-up with Medicare and Commercial insurance payers on escalated claims.</li><li>Assist in identifying the need for payer policy updates or process changes to support regulatory compliance and claim payment.</li><li>Participates in special projects as assigned.</li><li>Any other duties as assigned.</li></ul><p></p><p><b><br>
Essential Skills:</b></p><p>
The CPC Denials Escalation Analyst must be extremely detail-oriented. The CPC Denials Escalation Analyst must be able to comprehend all issues and articulate them to any person involved(s) needed to assist in their complete resolution. He/she must also possess:</p><div><ul><li>
Advanced analytical and reporting skills</li><li>
Basic understanding of rudimentary medical terminology</li><li>
Excellent judgment and decision-making</li><li>
Problem-solving and organizational skills</li><li>
Reliability, Accuracy, and Efficiency when dealing with patients or third-party payors</li><li>
Excellent verbal and written communication skills</li><li>
Ability to use good judgment in highly emotional and demanding situations</li><li>
Ability to react to frequent changes in duties and volume of work</li><li>
Excellent oral and written communication skills</li><li>
Ability to manage multiple tasks with ease and efficiency</li><li>
Ability to work independently with minimal supervision and be result-oriented</li><li>
Effective interpersonal skills, including the ability to promote teamwork</li><li>
Strong problem-solving skills</li><li>
Ability to ensure a high level of customer satisfaction, including employees, patients, physicians, and external stakeholders</li><li>
Maintains confidentiality of sensitive information</li><li>
Broad knowledge of health care business office practices and principles</li></ul></div><p></p><p><b><br>
Education and Experience Required:</b></p><div><ul><li>
CPC, CPB, or AHIMA associate's degree</li><li>
5+ years Revenue Cycle Management experience</li><li>
Strong understanding of CPT, HCPCS, accounts receivable, and charge capture workflows Experience with Athena, Epic, or comparable PM/EHR systems</li></ul></div></div></div></div></div><br>
Monday-Friday 8:30am-5:00pm</div>

CPC Denials Escalation Analyst

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Allied Digestive Health

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CPC Denials Escalation Analyst