Join R1 as a Denials Coding Associate III

R1 is seeking a skilled Denials Coding Associate III to review clinical documentation, apply accurate ICD-10-CM, CPT, and HCPCS codes, and support revenue cycle optimization. This role involves correcting billing edits, abstracting clinical data, and ensuring regulatory compliance. As part of our dynamic coding team, you’ll work with physicians and internal departments to maximize coding accuracy, resolve denials, and maintain productivity standards. This is an ideal opportunity for coding professionals experienced in denials, claim edits, and professional service coding.

Key Responsibilities for a Denials Coding Associate III

Accurate Coding & Data Abstraction

Assign ICD-10, CPT, and HCPCS codes for diagnoses, procedures, and treatments with the highest specificity.
Review medical records and physician-assigned codes; query providers for additional clarity as needed.
Accurately abstract clinical data into coding systems following established guidelines.
Validate codes, charges, and flagged edits in Athena or EPIC.

Denials & Compliance Management

Review documentation for returned accounts to correct billing, place of service, provider, and missing data elements.
Use CCI edit software to check for bundling issues, modifier appropriateness, and medical necessity (LCD/NCD).
Recommend coding guidance for charge corrections, appeals, and patient billing inquiries.
Ensure coding productivity and accuracy meet or exceed departmental standards (≥95% accuracy).

Qualifications & Experience

High school diploma or GED required.
Active CCS-P or CPC certification required.
Minimum of 4 years experience in coding denials and claim edits.
Extensive knowledge of official coding conventions (AMA ’95 & ’97 Documentation Guidelines).
Strong understanding of government and commercial payer rules.
Proficiency with standard office equipment and coding/information systems.
Excellent communication skills and ability to prioritize workloads effectively.

Compensation & Benefits

Base pay range: $20.13–$31.13/hour (determined by role, experience, location, and skills).
Competitive benefits package and opportunities for career growth.
Collaborative, innovative work environment with focus on professional development.
Opportunities to contribute to improved patient care and revenue cycle efficiency.

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Denials Coding Associate