Denials Coder

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🕒 December 11, 2025

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Remote Raven

WebsiteLinkedInAll Job Openings

11 - 50 employees

👥 HR Tech

🎯 Recruiter

🤝 B2B

HR Tech • Recruitment • B2B

Remote Raven is a company that connects businesses with highly qualified virtual assistants to fill various roles across multiple industries. They focus on providing professional, college-educated, and well-trained remote workers from the Philippines who can handle diverse tasks, including customer service, bookkeeping, digital marketing, HR, healthcare, and web development among others. Remote Raven ensures that these remote workers are fluent in English and hold relevant degrees or certifications. They offer a simple and affordable recruiting process without start-up fees, aiming to help companies streamline their staffing needs with reliable remote personnel.

📋 Description

• Analyze and resolve complex claim denials resulting from coding errors (CCI edits, medical necessity, bundling issues, and modifier usage). • Review medical records and "hard code" accurately from documentation to support appeals, ensuring the highest level of specificity for ICD-10-CM, CPT, and HCPCS levels. • Draft and submit comprehensive appeal letters to payers, citing appropriate coding guidelines (AMA, CMS) to overturn denials. • Identify trends in coding denials and provide feedback to the billing team or providers to prevent future rejections. • Utilize medical billing experience to understand the full lifecycle of a claim, ensuring that corrected codes are entered and rebilled according to payer-specific clearinghouse requirements. • Verify insurance eligibility and benefits when denials relate to coverage issues. • Collaborate with the accounts receivable team to ensure timely follow-up on aged claims. • Handle inbound inquiries from patients regarding billing questions or from insurance representatives regarding claim status. • Communicate effectively with providers to clarify documentation gaps that lead to coding denials.

🎯 Requirements

• Certification: Current CPC (Certified Professional Coder) certification through AAPC is required. • Experience: 2+ years of experience in medical coding is a plus, with a specific focus on working denial buckets. • Knowledge: Deep understanding of anatomy, physiology, and medical terminology. • Tech Stack: Proficiency with EMR/EHR systems (e.g., Insert specific software like Epic, eClinicalWorks, NextGen) and clearinghouses. • Hard Coding Mastery: Proven ability to code manually from the book/documentation without heavy reliance on CAC (Computer-Assisted Coding) software. • Billing Background: Previous experience in a Medical Biller role (posting payments, scrubbing claims, working AR) is a significant advantage. • Call Center Experience: Prior experience handling inbound calls in a mid-to-high volume healthcare or customer service setting is a plus.