Denials & Follow-Up Claims Specialist (Pediatrics)

About Us

Pediatrics 5280 is a growing pediatric practice dedicated to providing high-quality, compassionate care to children and families in the Centennial community. We are seeking a detail-oriented and proactive Denials & Follow-Up Claims Specialist to join our team.

Position Summary

The Denials & Follow-Up Claims Specialist is responsible for managing insurance claim denials, performing timely follow-up on outstanding claims, and ensuring maximum reimbursement for services rendered. This role plays a critical part in maintaining the financial health of the practice.

Key Responsibilities

• Review, analyze, and resolve denied or rejected insurance claims
• Conduct timely follow-up with insurance carriers on unpaid or underpaid claims
• Submit corrected claims and appeals with proper documentation
• Identify trends in denials and recommend process improvements
• Verify claim accuracy, including coding, billing, and patient information
• Communicate with internal teams regarding claim issues and resolutions
• Maintain detailed records of follow-up activities and outcomes
• Ensure compliance with payer guidelines and healthcare regulations

Qualifications

• Minimum 2 years of experience in medical billing, claims follow-up, or denial management (pediatrics experience preferred)
• Strong knowledge of insurance payers, EOBs (Explanation of Benefits), and denial codes
• Familiarity with CPT, ICD-10, and HCPCS coding
• Experience with electronic health records (EHR)
• Excellent analytical and problem-solving skills
• Strong attention to detail and organizational abilities
• Effective communication and follow-up skills

Preferred Qualifications

• Experience working in a pediatric or family practice setting
• Experience with EPIC EHR system
• Knowledge of Colorado Medicaid, and commercial insurance payers
• Certification such as CPC (Certified Professional Coder) or CPB (Certified Professional Biller) is a plus

Benefits

• Competitive hourly pay ($20–$25 based on experience)
• Health, dental, and vision insurance
• Paid time off and holidays
• Supportive and collaborative work environment
• Opportunities for growth and development

Keywords (for Indeed Optimization)

Medical Billing Specialist, Denials Specialist, Claims Follow-Up, Revenue Cycle Management, Insurance Claims, Medical Coding, CPT, ICD-10, HCPCS, EOB Review, Appeals and Denials, Healthcare Administration, Pediatric Billing, AR Specialist, Accounts Receivable Medical, Insurance Verification, Medicaid, Medicare, Commercial Insurance, EHR, Practice Management Software

Pediatrics 5280 is an equal opportunity employer.

Pay: $20.00 - $25.00 per hour

Benefits:

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

Work Location: In person