Medical Coding Denial Specialist

University of Colorado Medicine (CU Medicine) is the region’s largest and most comprehensive multi-specialty physician group practice. The CU Medicine team delivers business operations, revenue cycle and administrative services to support the patients of over 4,000 University of Colorado School of Medicine physicians and advanced practice providers. These providers bring their unparalleled expertise at the forefront of medicine to deliver trusted, compassionate health care services at primary and specialty care clinics as well as facilities operated by affiliate hospitals of the University of Colorado. We are seeking a detail-oriented and highly motivated Coding Denial Specialist to join our Accounts Receivable Resolution team. This role plays a critical part in protecting and optimizing revenue for CU Medicine providers by ensuring surgical claims are accurately reviewed, appealed, and resolved. This position offers the flexibility of being 100% remote, and qualified out-of-state candidates are encouraged to apply. The Denial Specialist is an advanced-level billing role within the revenue cycle team, responsible for resolving the organization’s most complex insurance denials. This position requires expertise in coding, payer guidelines, medical necessity criteria, and revenue cycle workflows. The Denial Specialist plays a critical role in maximizing reimbursement by analyzing, appealing, and high-complexity claims while maintaining strict quality and productivity standards. Essential Duties: Complex Denial Management

• Investigate, analyze, and resolve advanced denial categories, including:
• CPT and HCPCS coding denials
• Modifier-related denials
• Diagnosis-related denials
• Bundling and NCCI edits
• Medical necessity denials
• Interpret Explanation of Benefits (EOBs) and payer correspondence to determine root causes.
• Prepare and submit detailed, well-supported written appeals.
• Recommend appropriate coding corrections, rebilling strategies, or write-offs when warranted.

Medical Necessity Review

• Abstract and analyze procedure notes, clinical documentation, and patient history.
• Compare documentation against payer medical policies and coverage determinations.
• Articulate clearly and persuasively, in writing, when clinical and coding guidelines have been met.
• Collaborate with leadership and internal teams when documentation clarification is required.

Coding & Compliance Expertise

• Apply in-depth knowledge of CPT, HCPCS, ICD-10-CM, and modifier guidelines.
• Ensure alignment with national coding standards and CPC best practices.
• Identify when coding revisions are appropriate and compliant.
• Maintain strict adherence to regulatory and payer requirements.

Quality, Productivity & Performance Standards

• Meet or exceed stringent quantity and quality benchmarks.
• Maintain high first-pass resolution and successful appeal rates.
• Ensure accurate documentation of all account activity within the billing system.

Trend Analysis & Process Improvement

• Identify denial and rejection trends across payers, providers, and service lines.
• Provide data-driven recommendations to prevent recurring denials.
• Partner with analyst and leadership to implement corrective action plans.

Requirements:

• Minimum of 5 years of medical billing and denial management experience.
• Advanced knowledge of CPT, HCPCS, ICD-10-CM, modifiers, and payer billing guidelines.
• Strong understanding of medical necessity policies and coverage determinations.
• Ability to analyze clinical documentation and translate findings into persuasive written appeals.
• Exceptional written and verbal communication skills.
• Proven ability to meet strict productivity and quality standards.
• CPC (Certified Professional Coder) certification preferred.
• Experience with high-complexity or specialty-specific billing preferred.

All applications MUST be submitted via our website. In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information. CU Medicine is an Equal Opportunity Employer and complies with all applicable federal, state, and local laws governing non-discrimination in employment. We are committed to creating a workplace where all individuals are treated with respect and dignity, and we encourage individuals from all backgrounds to apply, including protected veterans and individuals with disabilities. CU Medicine is dedicated to ensuring a safe and secure environment for our staff and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees prior to their employment. The listed pay range (or hiring rate) represents CU Medicine’s good faith and reasonable estimate of the range of possible compensation at the time of posting and is based on evaluation of competitive market data. A variety of factors, including but not limited to, internal equity, experience, and education will be considered when determining the final offer. CU Medicine provides generous leave, health plans and retirement contributions which take your total compensation beyond the number on your paycheck. Find information about our benefits here. CU Medicine will post all jobs for a minimum of 7 days or until 250+ applicants have been received (whichever comes first). CU Medicine supports a Tobacco Free Workplace Environment which prohibits smoking and the use of tobacco products on CU Medicine property, Anschutz Medical Campus and adjacent business locations. Apply tot his job Apply To this Job