Horizon Recovery is hiring a Denials Coder to join our team. This role is highly focused on Denial Management and Revenue Integrity. We need an analytical problem-solver who can investigate unpaid claims, correct coding errors, and successfully appeal denials.

What You'll Do

Analyze and resolve complex claim denials resulting from coding errors, including CCI edits, medical necessity, bundling, and modifier usage.
Review medical records and 'hard code' accurately from documentation to support appeals, ensuring the highest level of specificity for ICD-10-CM, CPT, and HCPCS levels.
Draft and submit comprehensive appeal letters to payers, citing appropriate coding guidelines from AMA and CMS to overturn denials.
Identify trends in coding denials and provide feedback to the billing team or providers to prevent future rejections.
Utilize medical billing experience to understand the full claim lifecycle, ensuring corrected codes are entered and rebilled according to payer-specific clearinghouse requirements.
Verify insurance eligibility and benefits when denials relate to coverage issues.
Collaborate with the accounts receivable team to ensure timely follow-up on aged claims.
Handle inbound inquiries from patients regarding billing questions or from insurance representatives regarding claim status.
Communicate effectively with providers to clarify documentation gaps that lead to coding denials.

What We're Looking For

Current CPC (Certified Professional Coder) certification through AAPC is required.
Deep understanding of anatomy, physiology, and medical terminology.
Proficiency with EMR/EHR systems and clearinghouses.

Nice to Have

2+ years of experience in medical coding, with a specific focus on working denial buckets.
Proven ability to code manually from the book/documentation without heavy reliance on CAC (Computer-Assisted Coding) software.
Previous experience in a Medical Biller role (posting payments, scrubbing claims, working AR) is a significant advantage.
Prior experience handling inbound calls in a mid-to-high-volume healthcare or customer service setting.