CPC Denials Escalation Analyst
Job Description
Summary:
This position requires strong expertise in coding guidelines, payer policy, denials management, and claims processing. The CPC Denials Escalation Analyst 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.
Essential Responsibilities:
The responsibilities of the CPC Denials Escalation Analyst will include:
• Master claim denials and claims processing to support denial prevention strategies and drive claim resolution to payment.
• Review coding-related denials for potential correction and resubmission.
• Work assigned high-level A/R projects and complex claim investigations.
• Maintain adherence to quality and productivity standards established by the organization and industry guidelines.
• Follow up on escalated or project-related claims, working no fewer than 65–70 claims per day.
• Identify denial and payer trends and communicate findings to AR management.
• Conduct follow-up with Medicare and Commercial insurance payers on escalated claims.
• Assist in identifying the need for payer policy updates or process changes to support regulatory compliance and claim payment.
• Participates in special projects as assigned.
• Any other duties as assigned.
Essential Skills:
The CPC Denials Escalation Analyst must be extremely detail-oriented. The CPC Denials Escalation Analyst must be able to comprehend all issues and articulate them to any person involved(s) needed to assist in their complete resolution. He/she must also possess:
- Advanced analytical and reporting skills
- Basic understanding of rudimentary medical terminology
- Excellent judgment and decision-making
- Problem-solving and organizational skills
- Reliability, Accuracy, and Efficiency when dealing with patients or third-party payors
- Excellent verbal and written communication skills
- Ability to use good judgment in highly emotional and demanding situations
- Ability to react to frequent changes in duties and volume of work
- Excellent oral and written communication skills
- Ability to manage multiple tasks with ease and efficiency
- Ability to work independently with minimal supervision and be result-oriented
- Effective interpersonal skills, including the ability to promote teamwork
- Strong problem-solving skills
- Ability to ensure a high level of customer satisfaction, including employees, patients, physicians, and external stakeholders
- Maintains confidentiality of sensitive information
- Broad knowledge of health care business office practices and principles
Education and Experience Required:
- CPC, CPB, or AHIMA associate's degree
- 5+ years Revenue Cycle Management experience
- Strong understanding of CPT, HCPCS, accounts receivable, and charge capture workflows Experience with Athena, Epic, or comparable PM/EHR systems
Monday-Friday 8:30am-5:00pm