CPC Denials Escalation Analyst

Summary:

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.

Essential Responsibilities:

The responsibilities of the CPC Denials Escalation Analyst will include:

• Master claim denials and claims processing to support denial prevention strategies and drive claim resolution to payment.
• Review coding-related denials for potential correction and resubmission.
• Work assigned high-level A/R projects and complex claim investigations.
• Maintain adherence to quality and productivity standards established by the organization and industry guidelines.
• Follow up on escalated or project-related claims, working no fewer than 65–70 claims per day.
• Identify denial and payer trends and communicate findings to AR management.
• Conduct follow-up with Medicare and Commercial insurance payers on escalated claims.
• Assist in identifying the need for payer policy updates or process changes to support regulatory compliance and claim payment.
• Participates in special projects as assigned.
• Any other duties as assigned.

Essential Skills:

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:

Education and Experience Required: