Coding Denials and Appeals Specialist

Coding Denial And Appeals Specialist

The Coding Denial and Appeals Specialist is responsible for ensuring that workflows, processes, and data align with regulatory and payer requirements. This role focuses on reviewing and resolving clinical and medical-necessity denials for outpatient professional and facility services by identifying and correcting coding errors and ensuring compliance with all applicable guidelines.

We are committed to providing wage ranges for all open positions. Please note that the specific compensation for this role will be determined based on experience, education and internal equity considerations. The hourly wage range for this position is $27.74 - $39.16. This range reflects the base salary for this position.

Key Accountabilities

• Review, analyze, and resolve clinical and medical-necessity denials for outpatient professional and facility services.
• Identify and correct coding discrepancies to support accurate billing, compliant documentation, and appropriate reimbursement.
• Collaborate with internal teams, including coding, billing, and revenue cycle analyst and management to address denial trends and improve coding accuracy.
• Participate in post-billed account reviews and post-payment audits to support recovery efforts and reduce preventable denials.
• Use data and coding denial trends to recommend process improvements and support denial prevention strategies.
• Suggest coding education opportunities with HIM manager based on denial findings, coding errors, and documentation improvement opportunities.
• Maintain up-to-date knowledge of payer policies, regulatory requirements, and industry coding standards.
• Document all denial activities, corrections, and follow-up actions in accordance with organizational policies.
• Support special projects, audits, and initiatives related to coding quality, compliance, and revenue integrity as assigned.

Required Qualifications

• Minimum of three years of professional and outpatient/facility coding experience.
• One of the following credentials: Certified Professional Coder (CPC), Clinical Coding Specialist (CCS), or a Health Information Technology degree with RHIT or RHIA registration.
• Strong working knowledge of ICD-10/PCS, CPT, and HCPCS coding guidelines and regulatory requirements.
• At least two years of experience with denial workflows, work queue management, and coding software.

Preferred Qualifications

• Five years of professional and outpatient/facility coding experience.
• HFMA Certified Revenue Cycle Representative (CRCR) credential.

Schedule

• Full-time, 80 hours per two-week pay period
• Monday-Friday Business Hours
• Remote work setting, but must live in the state of Minnesota

Benefits Include

• Eligible for Shift Differential Pay in addition to base wage
• Paid Time Off accrued starting on first paycheck
• Medical, Dental, and Vision (discount plan) coverage
• Flexible Spending Accounts
• Life, AD&D, and Disability Insurance
• Pension Plan (PERA) with 7.5% employer match
• Optional 457(b) Retirement Plans
• Tuition Reimbursement
• Loan Forgiveness Eligibility – PSLF + MN state programs for qualifying roles
• Employer-Provided Certifications + Continuing Education
• Additional perks: Qualified Bilingual Staff Program, Employee Assistance Program, and discounts on cafeteria, scrubs, and OTC pharmacy items

Northfield Hospital + Clinics is a trusted, independent healthcare system with more than 800 employees. We're recognized for our collaborative work environment and strong commitment to high-quality patient care and community impact. We're proud to be named to Becker's 2025 list of "100 Great Community Hospitals." Our services span the full spectrum of hospital and clinical care, with our main hospital located in Northfield, MN, and primary and specialty clinics in Northfield, Lakeville, Farmington, Faribault, and Kenyon—along with Urgent Care locations in both Northfield and Lakeville. We offer care across 48 specialties and serve patients at 22 locations throughout the south metro and southern Minnesota.

Whether you're just starting your career or bringing years of experience, you'll find meaningful opportunities, supportive teams, and a chance to make a real difference here.