RCM Denial Claims Analyst Lead – Avon By The Sea, NJ

Allied Digestive Health is one of the largest integrated networks of gastroenterology care centers in the nation with over 200 providers and 60 locations throughout New Jersey and New York. As a fast-growing physician-led organization, our dynamic structure encourages physician input and decision-making, while simultaneously offering operational support. Our dedicated, compassionate team of providers prioritize personalized treatment plans for patients that deliver the highest quality of care. All of our doctors are board-certified in gastroenterology and hepatology. Several of them serve as chief of gastroenterology at nearby hospitals, and a number of them have been recognized as top-quality physicians in publications, including but not limited to: Best Doctors in America and Top Doctors New Jersey, and US News Health – US News & World Report.

We are excited to announce that we are looking for a Fulltime AR Denials and Escalation Analystat our Corporate office in West Long Branch NJ.

This position can be remote or hybrid

The AR Denials and Escalation Analyst responsibilities are

• Conducting medical coding audits to evaluate compliance with regulatory guidelines.
• Conducts coding, billing, and documentation compliance audits within established timeframe. Identifies need for new policy development/changes to meet regulatory requirements..
• Prepares a report of findings and recommendations for improvement for each audit.
• Serves as a subject matter expert on coding/billing topics

The AR Denials and Escalation Analyst must have the following qualifications and experience:

• 3+ years of relevant experience in a professional audit capacity required. Must have CPC, CRC, CGIC, CGOC from AAPC
• Strong technical knowledge of Institute of Internal Auditing (IIA) standards and Centers for Medicare & Medicaid Services (CMS) regulatory guidelines, including ICD-10 CM, CPT, and HCPCS Procedure Coding
• Proficiency in MS Office products – intermediate to advanced knowledge of MS Excel.
• Knowledge of Denials and Escalation

Job Type: Fulltime

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