At Proliance Surgeons our patients come from all walks of life - and so do we. We hire and support people from diverse backgrounds, fostering growth and development to make Proliance a great place to work. Our unique experiences and perspectives help us deliver
Exceptional Outcomes, Personally Delivered.
We are proud to offer a comprehensive and competitive benefit and pay package including health coverage, 401k with match and profit share, PTO and more! For further details regarding Benefits and Washington State Minimum Wage details please visit our careers page at www.proliancesurgeons.com/careers. Compensation during the offer process will be determined based on factors such as compensation structure, experience, qualifications, and internal equity. Be Part of Who We Are!
Position Summary
We are seeking a detail-oriented and analytical Revenue Cycle Coding Denial Specialist (Remote) to join our team. This role plays a key part in identifying denial trends, supporting Accounts Receivable (AR) workflows, and driving resolution through research, coding review, and appeal preparation.
The ideal candidate brings strong coding expertise, sharp critical thinking skills, and a solid understanding of the full-billing and reimbursement lifecycle. This position also serves as a coding float, providing flexible support and coverage across coding teams as needed.
Must have an active CPC certification with credentialing from AHIMA and/or AAPC.
Schedule
Full-time, Monday - Friday.
**Must live in one of the following states or be willing to relocate to: WA, ID, FL, NC, AZ, OH, OR, TN, TX, or RI.**
Key Duties and Responsibilities
The key duties and responsibilities of the Revenue Cycle Coder include, but are not limited to:
- Review and analyze denied claims to determine root cause and appropriate resolution
- Identify denial trends and collaborate with coding, billing, and AR teams to improve outcomes
- Prepare and submit detailed, compliant appeal letters with supporting documentation
- Perform coding reviews to ensure accuracy and alignment with payer guidelines, CPT, ICD-10-CM, and HCPCS standards
- Partner with AR team members to resolve complex accounts and reduce aging receivables
- Communicate with providers and staff to obtain necessary documentation or clarification
- Assist with education and feedback to coding and billing staff based on denial findings
- Maintain up-to-date knowledge of payer policies, regulatory requirements, and coding updates
- Provide coding support across specialties as needed in a float capacity
- Participate in process improvement initiatives to enhance revenue cycle performance.
- Demonstrates appropriate utilization of coding software and coding reference material.
- Follow up with providers on any documentation that is insufficient, missing, or unclear.
- Assists providers with questions regarding coding and documentation guidelines. Provides ongoing feedback based on observations from coding documentation and identifies opportunities for education and communicates trends to leaders.
- Keeps up to date on carrier policies/guidelines to ensure all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or Payer-specific guidelines.
Education/Experience
- Minimum 3 years of coding/medical billing experience
- Active CPC certification with credentialing from AHIMA and/or AAPC, must be maintained annually --- required
- ICD10 certified and/or extensive work experience
- Strong understanding of medical terminology, anatomy, and physiology
- Experience with denial management, AR workflows, and appeals
- Orthopedic coding experience strongly preferred
- Experience with NextGen and SIS systems preferred
Knowledge, Skills and Abilities
- A strong understanding of physiology, medical terms, and anatomy
- Thorough attention to detail
- Excellent written and verbal communication skills
- Self-motivated team player able to multi-task and prioritize
- Excellent organization and interpersonal communication skills
- Strong computer skills
- Strong computer skills/experience with Microsoft Excel, Outlook, and Adobe
- Working experience navigating EHR's to abstract documentation
Work Environment/Physical Demands
The work environment/physical demands described here are representative of those that must be met by a teammate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable differently abled persons to perform the essential functions.
Work may be performed in a remote office and clinical environment. Requires corrected vision and hearing to normal range. While performing the duties of this job, the associate is regularly required to talk or hear. The associate is required to sit for long periods of time, stand and walk, bend and stretch. Use of telephone and computer is required. Manual dexterity required for use of computer keyboard. Occasionally lifts and carries items weighing up to 40 pounds. May requires working under stressful conditions or working irregular hours.
