[Hiring] E/M Denial Research Specialist @CU Medicine

Role Description

We are seeking a highly motivated E/M Denial Research Specialist to join our Accounts Receivable Resolution team. This job can be performed 100% remotely, and out of state candidates will be considered.

The E/M Denial Research Specialist is responsible for reviewing, analyzing, and resolving Evaluation and Management (E/M) related coding denials to support accurate reimbursement and revenue integrity. This role applies established coding guidelines and documentation standards to determine the appropriate resolution, including write-offs, claim corrections, or payer reconsideration requests. The position also identifies denial trends and collaborates with leadership to proactively address recurring billing or payer issues.

Essential Duties:

• Research and analyze E/M coding denials to determine billing accuracy and compliance with coding guidelines.
• Recommend claim write-offs when E/M services are determined to be non-billable or not separately reimbursable.
• Identify and recommend necessary corrections to CPT levels, modifiers, or diagnosis codes when supported by clinical documentation.
• Draft and submit payer reconsiderations or appeals when E/M services are appropriately coded and supported by documentation.
• Monitor and report denial patterns, trends, and payer behavior to the Supervisor or Manager.
• Prioritize and manage a high volume of denial accounts while maintaining accuracy and quality standards.
• Maintain an in-depth understanding of current E/M coding guidelines, payer policies, and industry best practices.
• Meet established productivity standards, with a minimum production expectation of 50 accounts per day.
• Review denial documentation and claim details.
• Evaluate clinical documentation against E/M coding guidelines and payer policies.
• Determine the appropriate resolution pathway:
  • Write-off
  • Claim correction and rebill
  • Dispute or reconsideration submission

Qualifications

• Certified Professional Coder (CPC) or Certified Evaluation and Management Coder (CEMC) credential required.
• Bachelor’s degree in a related field or three to five (3–5) years of experience in medical practice billing required, including experience working with claim denials, appeals, and related follow-up activities.
• Strong working knowledge of medical terminology and human anatomy required.
• Demonstrated understanding of Evaluation and Management (E/M) coding guidelines, payer policies, and claims denial appeal processes.
• Ability to analyze denial root causes and apply appropriate resolution strategies, including claim corrections, reconsiderations, and write-offs.
• Experience interpreting and applying payer contract language and reimbursement policies.
• Intermediate proficiency with PC software and billing or revenue cycle management systems required.
• Advanced verbal and written communication skills, including the ability to prepare professional correspondence to payers and internal stakeholders.
• Strong analytical, organizational, and problem-solving skills with the ability to manage multiple accounts while meeting productivity and accuracy standards.
• Effective interpersonal and collaboration skills to work with physicians, coding teams, revenue cycle staff, and leadership.

Benefits

• Generous leave.
• Health plans.
• Retirement contributions which take your total compensation beyond the number on your paycheck.