E/M Denial Research Specialist

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🔥 5 minutes ago

⛰️ Colorado – Remote

⛰️ Colorado – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔬 Research Analyst

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Dayforce

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

👥 HR Tech

☁️ SaaS

🏢 Enterprise

💰 $1G Post-IPO Debt - Dayforce on 2024-03

HR Tech • SaaS • Enterprise

Dayforce is a cloud-based human capital management (HCM) platform developed by Ceridian. It combines payroll, HR, workforce management (time and attendance, scheduling), benefits administration, and talent management into a single SaaS application intended for HR teams and enterprise customers. Dayforce is sold primarily as a B2B solution to organizations seeking integrated, cloud-hosted workforce and payroll software.

📋 Description

• Research and analyze E/M coding denials to determine billing accuracy and compliance with coding guidelines. • Recommend claim write-offs when E/M services are determined to be non-billable or not separately reimbursable. • Identify and recommend necessary corrections to CPT levels, modifiers, or diagnosis codes when supported by clinical documentation. • Draft and submit payer reconsiderations or appeals when E/M services are appropriately coded and supported by documentation. • Monitor and report denial patterns, trends, and payer behavior to the Supervisor or Manager. • Prioritize and manage a high volume of denial accounts while maintaining accuracy and quality standards. • Maintain an in-depth understanding of current E/M coding guidelines, payer policies, and industry best practices. • Meet established productivity standards, with a minimum production expectation of 50 accounts per day. • Reviewing denial documentation and claim details. • Evaluating clinical documentation against E/M coding guidelines and payer policies. • Determining the appropriate resolution pathway: • Write-off • Claim correction and rebill • Dispute or reconsideration submission

🎯 Requirements

• Certified Professional Coder (CPC) or Certified Evaluation and Management Coder (CEMC) credential required. • Bachelor’s degree in a related field or three to five (3–5) years of experience in medical practice billing required, including experience working with claim denials, appeals, and related follow-up activities. • Strong working knowledge of medical terminology and human anatomy required. • Demonstrated understanding of Evaluation and Management (E/M) coding guidelines, payer policies, and claims denial appeal processes. • Ability to analyze denial root causes and apply appropriate resolution strategies, including claim corrections, reconsiderations, and write-offs. • Experience interpreting and applying payer contract language and reimbursement policies. • Intermediate proficiency with PC software and billing or revenue cycle management systems required. • Advanced verbal and written communication skills, including the ability to prepare professional correspondence to payers and internal stakeholders. • Strong analytical, organizational, and problem-solving skills with the ability to manage multiple accounts while meeting productivity and accuracy standards. • Effective interpersonal and collaboration skills to work with physicians, coding teams, revenue cycle staff, and leadership.

🏖️ Benefits

• generous leave • health plans • retirement contributions