CPC Denials Escalation Analyst

CPC Denials Escalation Analyst

We are hiring for a CPC Denials Escalation Analyst at our Central Business Office in West Long Branch, NJ

Summary:

This position requires strong expertise in coding guidelines, payer policy, denials management, and claims processing. The CPC Denials Escalation Analyst will serve as a subject-matter expert on denied-claim escalations, contribute to denial-prevention strategies, perform chart reviews, and ensure claims are properly adjudicated for payment. The role supports complex A/R projects, denial coding reviews, and compliance audits while maintaining productivity and quality standards aligned with regulatory and organizational requirements.

Essential Responsibilities:

The responsibilities of the CPC Denials Escalation Analyst will include:

• Master claim denials and claims processing to support denial prevention strategies and drive claim resolution to payment.

• Review coding-related denials for potential correction and resubmission.

• Work assigned high-level A/R projects and complex claim investigations.

• Maintain adherence to quality and productivity standards established by the organization and industry guidelines.

• Follow up on escalated or project-related claims, working no fewer than 65–70 claims per day.

• Identify denial and payer trends and communicate findings to AR management.

• Conduct follow-up with Medicare and Commercial insurance payers on escalated claims.

• Assist in identifying the need for payer policy updates or process changes to support regulatory compliance and claim payment.

• Participates in special projects as assigned.

• Any other duties as assigned.

Education and Experience Required:

CPC, CPB, or AHIMA associate's degree

• 5+ years Revenue Cycle Management experience

• Strong understanding of CPT, HCPCS, accounts receivable, and charge capture workflows

• Experience with Athena, Epic, or comparable PM/EHR systems

We offer competitive base salary, generous benefits, including Medical, Dental, Vision, Life Insurance, Voluntary, Time-Off Benefits, EAP, 401K and Commuter Benefits.