Coding Denials Specialist

Job Title

Coding Denial And Appeal Specialist

Job Description

Catholic Health is one of Long Island's finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

Job Details

The Coding Denial and Appeal Specialist is responsible for managing coding-related claim denials and ensuring escalation for timely and accurate appeals to payers. This role requires in-depth knowledge of medical coding, payer policies, and denial management processes. The specialist will analyze denied claims, identify root causes, and collaborate with coders, physicians, and billing teams to ensure proper documentation and maximize reimbursement.

Key Responsibilities

• Review and analyze denied medical claims related to coding (CPT, ICD-10, HCPCS, modifiers, etc.).
• Determine the root cause of coding denials and identify trends or systemic issues.
• Communicate with payers, providers, and internal teams to resolve coding-related denials.
• Stay current with federal and state coding regulations, payer policies, and industry best practices.
• Collaborate with coding, billing, and compliance teams to ensure coding accuracy and prevent future denials.
• Generate and report denial metrics to leadership as required.

Required Qualifications

Education:

• High School Diploma or GED (required)
• Associate's or Bachelor's Degree in Health Information Management, Healthcare Administration, or related field (preferred)

Certification:

• CPC, COC, or CIC (AAPC) or CCS, CCS-P (AHIMA) certification required.

Experience:

• 2+ years of experience in medical coding and/or denial management
• Strong knowledge of CPT, ICD-10-CM, HCPCS coding, and medical terminology
• Familiarity with payer-specific guidelines and medical necessity policies
• Experience using EHR and billing systems (e.g., Epic, Cerner, Meditech, etc.)
• Experience working in a hospital, physician group, or health system environment
• Familiarity with Medicare, Medicaid, and commercial payer appeal processes
• Previous experience using denial management software or appeal automation tools

Skills and Competencies:

• Excellent written communication and persuasive writing skills
• Detail-oriented with strong analytical and problem-solving abilities
• Ability to manage time and meet strict deadlines for appeals
• Proficient in Microsoft Office Suite (especially Word and Excel)
• Ability to work independently and as part of a cross-functional team
• Knowledge of healthcare reimbursement methodologies (e.g., DRG, APC, RBRVS)

Performance Metrics/KPI's

• Denial reduction trend for coding-related claims
• Productivity metrics of avg 8-12 claims per hour
• Quality – minimum of 90% accuracy
• Root cause analysis and education completion rate

Posted Salary Range

USD $66,300.00 - USD $74,000.00 /Yr.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate's qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.