Claims A/R and Denial Analyst Escalations – CPC Lead

We are hiring for a Claims A/R and Denial Analyst Escalations - CPC Lead 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 Claims CPC A/R and Denial Analyst Escalations Lead 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 Claims A/R and Denial Analyst Escalations - CPC Lead will include:

• Serve as subject matter expert (SME) for escalated claim denials from vendors and internal RCM teams.

• 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 and senior leadership.

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

• Perform coding, billing, and documentation compliance audits within established timelines.

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

• Prepare reports summarizing audit findings and recommendations for operational improvement.

• Participates in special projects as assigned.

• Any other duties as assigned.

Essential Skills:

The Claims A/R and Denial Analyst Escalations - CPC Lead must be extremely detail oriented. The Claims A/R and Denial Analyst Escalations - CPC Lead must be able to comprehend all issues and be able to articulate those issues to any involved person(s) needed to assist in their complete resolution.

Education and Experience Required:

CPC, CPB or AHIMA associates degree

• 5+ years Revenue Cycle Management experience

• Strong understanding of CPT, HCPCS, 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.

Monday-Friday 8:30am-5:00pm