Denials Specialist

Job Summary: Bladder & Bowel Institute is in search of a dedicated and detail-oriented Healthcare Denials Coordinator to join our team. The candidate will be responsible for managing and appealing denied claims, establishing and maintaining relationships with payor representatives to facilitate claim resolutions, and conducting thorough follow-ups on claim denials. This role requires strong communication skills, analytical thinking, and a commitment to ensuring accurate and timely reimbursement.

Key Responsibilities:

· Review denied claims to identify reasons for denials and determine appropriate action steps.

·Prepare and submit comprehensive appeal letters and packages to payors within established timelines.

·Collaborate with clinical staff and other departments to gather supporting documentation for appeals.

·Track and monitor the status of appeals, ensuring resolution is achieved promptly.

· Develop and maintain positive working relationships with payor representatives.

· Act as subject matter expert on denials and take full ownership of the denials and appeals process.

· Serve as the primary point of contact for escalations and inquiries related to claim denials.

· Stay updated on payor policies, procedures, and updates to ensure compliance and optimize claim success rates.

· Analyze denial trends and root causes to create comprehensive reports to upper management, including actionable recommendations and possible solutions.

· Follow up on unresolved claims and ensure all necessary actions are taken to secure reimbursement.

· Maintain accurate records of denial and appeal activities in the appropriate systems.

· Generate regular reports to provide insights on denial management performance and outcomes.

· Ensure all activities comply with federal, state, and local regulations, as well as organizational policies.

· Continuously review industry best practices to improve the effectiveness of the denial management process.

Qualifications:

· Bachelor’s degree in healthcare administration, business, or a related field required; equivalent work experience considered.

·Minimum of 3 years of experience in healthcare denials management, or related role.

· Strong understanding of insurance payor policies, claim submission processes, and denial reasons.

· Excellent written and verbal communication skills.

· Ability to analyze data, identify trends, and recommend solutions to prevent future denials.

·Exhibit excellent prioritization and time management skills, capable of multitasking and shifting focus seamlessly between various tasks.

· Be eager to learn and adapt, with a relentless drive to find solutions to new and existing challenges.

· Possess computer skills, including proficiency in Microsoft Office, and familiarity with standard office equipment and phone systems.

If you are a self-motivated individual with a passion for healthcare, we encourage you to apply for this exciting opportunity to make a difference in the lives of patients struggling with bladder and bowel control problems.

Job Type: Full-time

Pay: $70,000.00 - $90,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

People with a criminal record are encouraged to apply

Application Question(s):

• Do you have at least 3 years of experience in healthcare denials management, or related role?

Work Location: Remote

Salary : $70,000 - $90,000