Claims A/R and Denial Analyst Escalations - CPC Lead

Job Description

We are hiring for a Claims A/R and Denial Analyst Escalations - CPC Lead at our Central Business Office in West Long Branch, NJ \n
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Summary: \n
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\nThis position requires strong expertise in coding guidelines, payer policy, denials management, and claims processing. The Claims CPC A/R and Denial Analyst Escalations Lead 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.\n
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Essential Responsibilities: \n
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\nThe responsibilities of the Claims A/R and Denial Analyst Escalations - CPC Lead will include:\n
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\n• Serve as subject matter expert (SME) for escalated claim denials from vendors and internal RCM teams.\n
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\n• Master claim denials and claims processing to support denial prevention strategies and drive claim resolution to payment.\n
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\n• Review coding-related denials for potential correction and resubmission.\n
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\n• Work assigned high-level A/R projects and complex claim investigations.\n
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\n• Maintain adherence to quality and productivity standards established by the organization and industry guidelines.\n
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\n• Follow up on escalated or project-related claims, working no fewer than 65-70 claims per day.\n
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\n• Identify denial and payer trends and communicate findings to AR management and senior leadership.\n
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\n• Conduct follow-up with Medicare and Commercial insurance payers on escalated claims.\n
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\n• Perform coding, billing, and documentation compliance audits within established timelines.\n
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\n• Assist in identifying the need for payer policy updates or process changes to support regulatory compliance and claim payment.\n
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\n• Prepare reports summarizing audit findings and recommendations for operational improvement.\n
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\n• Participates in special projects as assigned.\n
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\n• Any other duties as assigned.\n
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Essential Skills: \n
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\nThe Claims A/R and Denial Analyst Escalations - CPC Lead must be extremely detail oriented. The Claims A/R and Denial Analyst Escalations - CPC Lead must be able to comprehend all issues and be able to articulate those issues to any involved person(s) needed to assist in their complete resolution.\n
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Education and Experience Required: \n
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\nCPC, CPB or AHIMA associates degree\n
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\n• 5+ years Revenue Cycle Management experience\n
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\n• Strong understanding of CPT, HCPCS, and charge capture workflows\n
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\n• Experience with Athena, Epic, or comparable PM/EHR systems\n
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\nWe offer competitive base salary, generous benefits, including Medical, Dental, Vision, Life Insurance, Voluntary, Time-Off Benefits, EAP, 401K and Commuter Benefits.\n
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\nMonday-Friday 8:30am-5:00pm