Denial Mangement Specialist

The Denial Specialist is responsible for managing, tracking, and resolving denied insurance claims in a timely manner. This role involves working closely with internal departments and external insurance companies to ensure claims are appropriately appealed, corrected, and re-submitted for payment. Additionally, coordinator will work with training team to develop any education for providers and staff following denial trends to ensure that procedures are ordered in accordance with insurance guidelines.

Essential Functions:

• Analyze and identify reasons for denial of claims.
• Review denied claims for accuracy and eligibility.
• Ensure that claims are coded correctly and in compliance with payer requirements.
• Develop and submit appeal letters and supporting documentation for denied claims.
• Track all appeals and follow up to ensure timely resolution.
• Communicate with insurance companies to resolve discrepancies and prevent future denials.
• Work with healthcare providers, coding specialists, and billing departments to resolve issues related to denials.
• Serve as the primary point of contact for other departments and insurance companies regarding claim denials.
• Generate and review regular reports on denial trends to identify recurring issues.
• Provide feedback to management on denial patterns and suggest corrective actions to reduce future denials.
• Ensure all processes are in compliance with industry regulations and payer-specific guidelines.
• Maintain a comprehensive knowledge of insurance payer policies and procedures.
• Communicate professionally with patients to inform them of claim denials and necessary actions. Assist in  resolving patient billing issues arising from denied claim.

Minimum/Preferred Qualifications:

• High School Graduate or equivalent required. Associates Degree preferred.
• Three (3) to five (5) years medical billing experience strongly preferred.

Knowledges/Skills and Abilities:

• Understanding of insurance policies, healthcare regulations, medical terminology, and coding systems (ICD-10, CPT, etc.).
• Ability to identify errors and discrepancies in claim submissions.
• Strong written and verbal communication skills for effective interaction with insurance companies, healthcare staff, and patients.
• Ability to assess situations and propose solutions to resolve claim issues. Organized and have a thorough understanding of Microsoft Office and Excel. 

This position is fully remote

Our Billing Co. offers a competitive benefits package.

Pay range:  $20.00 - $26.00

Individual annual salaries/hourly rates will be set within job's compensation range, and will be determined by considering factors including, but not limited to market data, education, experience, qualifications, and experience, qualifications, and expertise of the individual and internal equity considerations.

This position requires constant sitting in an office environment. Employees may be asked to occasionally perform other movements or physical tasks. Workplace accommodations may be available for employees in accordance with the Americans with Disabilities Act.

Salary : $20 - $26