Job Description
Job Description
Job Title : Denials and Appeals Representative / Medical Claims Analyst
Location : Plano, TX 75093
Industry : Healthcare
Pay : $50,000 - $60,000 / year Monthly Bonuses ($1,000–$3,000 / month based on performance)
Position Overview :
As a Denials and Appeals Representative / Medical Claims Analyst, you’ll play a pivotal role in resolving aged claims and handling complex denials for facility accounts. This role is perfect for someone with a strong background in revenue cycle management (RCM), particularly in denials, appeals, and facility collections.
Key Responsibilities :
Denials & Appeals Management :
- Analyze and resolve insurance denials, focusing on facility claims and UB04s.
- Write comprehensive appeals, not just adding status updates to accounts.
- Handle prior authorization denials with a strategic approach beyond simply sending medical records.
Claims Analysis & Collections :
Push aged claims (2–10 years old) to resolution and ensure timely cash collections.Work on commercial facility claims, ensuring accuracy and compliance with insurance contracts.Maintain a productivity rate of 18 claims per day, focusing on in-depth resolution of complex cases.Full Revenue Cycle Involvement :
Utilize knowledge of the full RCM process to navigate claims issues efficiently.Identify patterns in denials and suggest process improvements.Qualifications : Experience :
3 years of experience in denials and appeals, with the ability to write appeals independently.Background in facility collections and working with UB04s.Strong knowledge of RCM processes, including handling complex insurance denials.Clinical denials experience is a plus.Technical Skills :
Familiarity with various EMR systems, depending on the client.Understanding of insurance contracts, claim processes, and commercial billing practices.Soft Skills :
Strong critical thinking and problem-solving abilities.Ability to work independently without micromanagement in a fast-paced environment.Detail-oriented with a focus on compliance and accuracy.Additional Details :
Compensation & Benefits
Base Salary : Up to $60,000 / year (negotiable for highly qualified candidates).
Bonus Structure : Earn 3% of collected claims, averaging $1,000–$3,000 / month.
Benefits :
70% of health benefits covered by the company.Daily catered lunches provided in the office.Work in a modern, Google-inspired office with top-tier amenities.Why Join this team?
Growth Opportunity : Join a fast-expanding team with opportunities to advance as the company scales.Innovative Environment : Work in a tech-savvy, Google-like office designed to foster collaboration and productivity.Competitive Pay & Bonuses : With a strong base salary and substantial bonuses tied to performance, your hard work directly impacts your earnings.Ideal Candidate Profile :
Must Have :
Strong background in denials and appeals with the ability to write effective appeals.Experience in facility claims, UB04s, and aged claims resolution.Full RCM knowledge with the ability to troubleshoot complex claims issues.Preferred Fit :
Critical thinkers who can provide solutions beyond the standard approach (e.g., offering more than just “sending medical records” to resolve prior auth denials).Self-motivated professionals who can thrive in a tough, high-performance environment without constant oversight.Potential Challenges & Expectations :
High-Pressure Environment : Candidates must be comfortable with complex, aged claims and able to handle the pressure of resolving difficult denials.Limited Flexibility in Hours : Standard hours are 7 AM – 4 PM or 8 AM – 5 PM; candidates are expected to stick with their chosen schedule.Independent Work Ethic : This is not a role for someone who needs micromanagement. The ideal candidate will be able to identify problems and implement solutions proactively.Ready to Apply?
If you're a detail-oriented problem solver with a passion for medical claims and denials, this is your chance to join a fast-growing team in a dynamic environment.
Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.
Salary : $50,000 - $60,000
