What are the responsibilities and job description for the Denial Resolution Specialist position at Community Clinic?
Job Summary
Community Clinic is seeking an experienced medical claims processor to join our team as a Denial Resolution Specialist. This person will be responsible for the investigation and resolution of denied claims and will take a lead role in overseeing the revenue cycle process from a claims and billing perspective. This is a full-time M-F position. 2 years of experience in medical billing, coding, or revenue cycle management required. Certifications (e.g. CPC, CRCR, CHFP) preferred.
Key Responsibilities
- Investigates, resolves, and appeals complex claim denials, including medical necessity, authorization, and coordination of benefits issues.
- Prepares and submits clean claims to third-party payers electronically or via paper.
- Manages payer follow-ups for outstanding and denied claims, ensuring resolution within compliance timeframes.
- Issues adjusted, corrected, and rebilled claims as needed to facilitate accurate reimbursement.
- Works closely with coding, revenue allocation, operations and patient accounting teams to ensure accurate claims processing.
- Investigates and resolves payer and clearinghouse claim rejections.
- Assists with inquiries and patient billing issues, ensuring clear and professional communication.
- Documents all denial resolutions and appeals activity accurately.
- Identifies denial and rejection trends, recommends corrective actions, and collaborates with leadership to reduce future denials and rejections.
- Mentors, trains and supports staff in understanding denial resolution and payer requirements.
- Assists with miscellaneous medical claims projects, staff coverage, peer reviews, and other tasks as needed.
Qualifications
- High school diploma or equivalent required.
- At least two years of experience in medical claims processing, denial resolution, and appeals required.
- Certifications in medical billing, coding, or revenue cycle management preferred (e.g., CPC, CRCR, CHFP).
- Experience in a Federally Qualified Health Center (FQHC) preferred.
- Extensive experience in professional billing, denial resolution, and appeals.
- Strong knowledge of eCW, medical billing systems, and clearinghouses.
- Familiarity with CPT, HCPCS, ICD-10 coding, revenue codes, occurrence codes, condition codes and common payer guidelines.
Why Join Community Clinic?
Be a part of a mission driven organization providing comprehensive health care to everyone in your community, regardless of their financial or medical situation!
Automatic 5% contribution to employee retirement plan, no match required!
Competitive pay, time-off, and 10 annual paid holidays!
