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 assigned claim edits and rejection work queues • Investigate and resolve health plan denials in a timely manner • Process rejections, down codes, bundling issues, modifiers, level-of-service issues, and other assigned queues • Resolve work queues according to prescribed priorities, management direction, policies, procedures, and job aids • Validate denial reasons and coding accuracy • Generate appeals based on dispute reasons and payer contract terms, including online reconsiderations • Follow payer-specific appeal submission guidelines • 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, emphasizing 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 proficiency with internal systems • Knowledge of Outlook, Word, Excel, including pivot tables, and database software • Ability to work in a fast-paced environment • Good organizational and analytical skills • Ability to work independently and collaboratively • Effective oral, written, and interpersonal communication skills • Basic computer, telephone, internet, copier, fax, and scanner skills • Basic touch 10-key skills • Basic math skills • Ability to comply with company policies and procedures • Strong time-management and organizational skills

🏖️ Benefits

• Performance-based incentive plan • Referral bonus for referring a friend • Reasonable accommodations for qualified individuals with disabilities