Denial Management Specialist

Job Description

REQUIREMENTS

• Education:

High school diploma or equivalent required; Active coding certification through AHIMA or AAPC

• Experience:

Minimum of 2 years’ experience in medical billing, coding, or denial management.

• Knowledge:

Strong knowledge of insurance claim processes, coding (CPT, ICD-10, HCPCS), payer requirements, and healthcare reimbursement systems. Familiarity with HIPAA regulations and healthcare compliance standards is essential.

• Attention to Detail:

Ability to thoroughly analyze denied claims, identify issues, and resolve them effectively while maintaining a high level of accuracy and production metrics.

• Communication Skills:

Strong written and verbal communication skills to interact with insurance companies, healthcare providers, and patients professionally and efficiently.

• Problem-Solving:

Excellent critical thinking and problem-solving abilities to manage and resolve complex denial issues.

• Organizational Skills:

Ability to manage multiple tasks and priorities in a fast-paced environment while meeting deadlines.

Technical Skills:
Proficient in Microsoft Office Suite (Excel, Word, Outlook) and billing software; experience with denial management systems is a plus.

RESPONSIBILITIES

• Denial Resolution:

Review and analyze denied claims to determine the reason for denial and take appropriate action to resolve the issue. This may include appealing, correcting errors, or obtaining additional information from the provider or payer.

• Documentation & Recordkeeping:

Accurately document and maintain records of denied claims, appeals, and correspondence with payers. Track the status of denied claims and escalate issues as necessary.

• Insurance Verification:

Verify patient insurance information, ensuring that billing is accurate, and all coding is correct prior to submission. Work with patients and insurance companies to resolve issues related to eligibility and coverage.

• Collaboration:

Collaborate with internal teams, including billing, coding, and customer service, to gather necessary documentation, correct errors, and ensure that all claims are processed appropriately.

• Appeals Process:

Prepare and submit appeals for denied claims, including gathering appropriate medical records, coding adjustments, or other supporting documentation. Monitor the progress of appeals and follow up to ensure timely resolution.

Are you interested in this position?

Apply by clicking on the “Apply Now” button below!

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