Denial Resolution Specialist

Job Summary

Who We Are

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Location: This position will be hybrid, with opportunity to work full remote after training as well as in our La Grange, KY office.

About the Opportunity

At Machinify, we’re constantly reimagining what’s possible in our industry—creating disruptively simple, powerfully clear ways to maximize our clients’ financial outcomes today and drive down healthcare costs tomorrow. As part of the Carrier to Carrier team, you will communicate with a variety of insurance companies for payment resolution. We are looking for candidates who can communicate persuasively, with a clear understanding of denial codes and reasons, and help formulate responses to those denials. The Denial Resolution Specialist will also assist in other administrative duties including working in other payer systems to do claim follow up.

What you’ll do

• Phone contact with insurance carriers for the resolution and explanation of insurance denials.
• Comprehensive understanding of insurance EOBs
• Reviewing claims, Reporting Denial trends, Keeping detailed records of communications with Insurance Companies.
• Coordinating with providers to inquire about medical records and documentation needed for claim processing.
• Knowledge of filing and tracking medical insurance appeals
• Maintaining and adhering to the responsibility for client access, for the retrieval of claim forms that our billing specialist need.
• Maintains and records all communication with insurance companies and keeps a follow schedule.
• Must have excellent follow up and follow through skills.

What experience you bring (Role Requirements)

• Bachelor’s Degree preferred or equivalent combination of education and experience in the health insurance, related fields, which would provide the necessary knowledge, skills, and abilities to successfully perform the work.   Experience.
• At least two years of experience as a Denial Resolution Specialist/Recovery Specialist
• Communication experience with insurance companies.
• Good oral and written communication skills, including excellent phone communication skills.
• Strong organizational and administrative skills
• Ability to work well in a team environment.
• Ability to multi-task and work independently as required. 
• Excellent time management and analytical skills required. 
• Always displays professional behavior in dealings with clients, members, peers, trainees, Audit management and any other individual with whom this position interacts.  This applies equally to personal, written or telephone contact.

What Success Looks Like…

After 3 months

You will have a strong understanding of the role.

You begin building relationships and collaborating with peers.

You develop effective time and priorities management.

You receive initial feedback about your performance and are using it to improve.

You’ve gained confidence in your abilities and are starting to feel more comfortable in your role.

After 1 year

You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.

You have established a strong network of internal relationships and are recognized as a key collaborator.

You’ve been entrusted with greater responsibility indicating the company’s confidence in your abilities.

You see opportunities for career progression and personal development.

Pay range: This is a non-exempt position. Compensation will be determined based on several factors including, but not limited to, skill set and years of experience.

What’s in it for you      

• PTO, Paid Holidays, and Volunteer Days
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options

At Machinify, we’re reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.

Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally, abandoning silos, to bring innovative, accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, Machinify is making healthcare work better for everyone, and we’re passionate about a future with better outcomes for all.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer.