Provider Denial Coding Dispute Specialist

This role provides support for provider denial coding dispute activities by investigating and resolving disputes related to provider appeals. The position ensures that claims adhere to correct billing standards and regulations through systematic review of medical records and claim history. It involves conducting independent audits to verify billing accuracy and making decisions to overturn or uphold denials. The specialist also communicates determinations to providers and collaborates with internal departments to ensure precise code editing and compliance.