Coding Denials Specialist

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Ventra Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2021

🏥 Healthcare

☁️ SaaS

🤝 B2B

Healthcare • SaaS • B2B

Ventra Health is a healthcare revenue cycle management (RCM) company that provides end-to-end medical billing, coding, claims management, denial prevention, payer contracting, and collections services for hospitals, health systems, and physician practices across the U. S. Its offerings combine domain expertise and white‑glove client service with proprietary data and AI-powered platforms—vCision (AI & automation) and vSight (data & analytics)—to improve reimbursement, reduce denials, accelerate cash collections, and deliver measurable RCM performance improvements. Ventra emphasizes enterprise service delivery, provider education, compliance and coding audits, patient responsibility management, and payer strategy, serving thousands of providers and facilities nationwide.

📋 Description

• Process accounts meeting coding denial management criteria, including rejections, down codes, bundling issues, modifiers, level of service, and other assigned queues • Resolve work queues according to prescribed priority or management direction, following policies, procedures, and job aids • Investigate health plan denials and determine appropriate actions and resolutions • Validate denial reasons and coding accuracy • Generate appeals based on dispute reasons and payer-specific contract terms, including online reconsiderations • Follow payer guidelines for appeal submissions • Escalate exhausted appeal efforts for resolution • Meet departmental production and quality standards • Complete special projects assigned by management • Maintain working knowledge of departmental workflows, systems, and tools

🎯 Requirements

• High school diploma or equivalent • One to three years’ experience in physician medical billing, with emphasis on research and claim denials • Current AAPC or AHIMA certification required • Knowledge of health insurance and coding • Thorough knowledge of physician billing policies and procedures • Thorough knowledge of healthcare reimbursement guidelines • Knowledge of AHA Official Coding and Reporting Guidelines, CMS, and other agency directives for ICD-10-CM and CPT coding • Computer literacy and ability to learn applicable internal systems • Working knowledge of Excel helpful • Ability to work in a fast-paced environment • Good organizational and analytical skills • Ability to work independently and collaboratively toward shared goals • Effective and efficient communication skills • Basic use of computer, telephone, internet, copier, fax, and scanner • Basic touch 10-key skills • Basic math skills • Ability to understand and comply with company policies and procedures • Strong oral, written, and interpersonal communication skills • Strong time management and organizational skills • Strong knowledge of Outlook, Word, Excel, including pivot tables, and database software

🏖️ Benefits

• Ventra performance-based incentive plan • Referral bonus for referring a friend • Discretionary incentive bonus in accordance with company policies • Reasonable accommodations for qualified individuals with disabilities