CPC Denials Escalation Analyst

CPC Denials Escalation Analyst

We are hiring for a CPC Denials Escalation Analyst at our Central Business Office in West Long Branch, NJ.

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.

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 6570 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.

Education and Experience Required:

• CPC, CPB, or AHIMA associate's degree
• 5+ years Revenue Cycle Management experience
• Strong understanding of CPT, HCPCS, accounts receivable, and charge capture workflows
• Experience with Athena, Epic, or comparable PM/EHR systems

We offer competitive base salary, generous benefits, including Medical, Dental, Vision, Life Insurance, Voluntary, Time-Off Benefits, EAP, 401K and Commuter Benefits.

Monday-Friday 8:30am-5:00pm