denial management specialist

UT Southwestern Medical Center

WHY UT SOUTHWESTERN?
<br>With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report , we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career!
<br><br>
JOB SUMMARY
<br>The Revenue Cycle Department team has a new opportunity available for the role of Clinical Denial Management Specialist II. Works under intermediate level billing/denial responsibilities. The expectations for this position shall include but not be limited to the following: Two (2) years' follow-up / collections experience is strongly preferred. Review, research, and resolve denial of professional claims related to CPT codes, place of service, modifiers, and payer policies. Reconcile expected payment and make necessary adjustments as required by plan reimbursement. Review and interpret documentation. Prepare and submit appeals to payers based on payor guidelines. Contact payers regarding reimbursement of denied claims. Review accuracy of payment to account Resolve discrepancy between insurance and billing. Provide feedback on denial trends to leadership.
<br><b>Shift:</b> Flex shift, start time between 0600-0900.
<br><b>Work from home (WFH):</b> This is a work from home position. Applicants must live in the state of Texas. Additional details shall be discussed as part of the interview process.
<br><br>
BENEFITS
<br>UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:
<br>PPO medical plan, available day one at no cost for full-time employee-only coverage
<br>100% coverage for preventive healthcare-no copay
<br>Paid Time Off, available day one
<br>Retirement Programs through the Teacher Retirement System of Texas (TRS)
<br>Paid Parental Leave Benefit
<br>Wellness programs
<br>Tuition Reimbursement
<br>Public Service Loan Forgiveness (PSLF) Qualified Employer
<br>Learn more about these and other UTSW employee benefits!
<br>EXPERIENCE AND EDUCATION
<br><br>
Required
<br>Education
<br>High School Diploma or equivalent or
<br><br>
Experience
<br>2 years medical billing or collections experience and
<br>Must demonstrate the ability to work clinical denials for complex E&M services, diagnostic studies, and/or minor surgical procedures and
<br>Must demonstrate a strong knowledge of medical claims recovery and/or collections rules and regulations
<br><br>
Preferred
<br>Education
<br>Coding certifications (CPC, CPMA, CMC, ART, RRA, RHIA, RHIT, CCS, CCA) and/or degrees (associate level, bachelor level, master level) are preferred and may be considered in lieu of experience.
<br><br>
Licenses and Certifications
<br>(CPC) CERT PROFESSIONAL CODER Upon Hire or
<br>(CPMA) Cert Prof Medical Auditor Upon Hire or
<br>(CMC) CERT MEDICAL CODER Upon Hire or
<br>(ART) ASSOC RECORDS ADMIN Upon Hire or
<br>(RRA) REGISTERED RECORDS ADMIN Upon Hire or
<br>(RHIA) REGD HEALTH INFO ADMINIST Upon Hire or
<br>(RHIT) REGD HEALTH INFO TECHNOLO Upon Hire or
<br>(CCS) CERT CODING SPECIALIST Upon Hire or
<br>(CCA) Cert Coding Associate Upon Hire
<br><br>
JOB DUTIES
<br>Review, research and resolve coding denials for E&M services, diagnostic studies, and minor surgical procedures. This includes denials related to the billed E&M, CPT, diagnosis, and modifier. Denial types could include bundling, concurrent care, frequency and limited coverage. Prepare and submit claim appeals, based on payor guidelines, on moderate complexity coding denials. Identify denial, payment, and coding trends in an effort to decrease denials and maximize collections.
<br>Contact payers, via website, phone and/or correspondence, regarding reimbursement of claims denied for coding related reasons. Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
<br>Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and or paper/fax processes. Requires proven analytical, and decision making skills to determine what selective clinical information must be submitted to properly appeal the denial. Requires proven knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of the specialty service line. This position requires clear and concise written and oral communication with payors, providers, and billing staff to insure resolution of moderate complex coding denials.
<br>Read and interpret E&M notes, diagnostic study results and or minor procedure notes. Based on the documentation review, confirm or change the billed CPT code(s), diagnosis code(s) and modifiers (if applicable) in order to attain denial resolution. Requires proven knowledge of the specialty specific service line documentation requirements. Must be familiar with the Medicare and Medicaid teaching physician documentation billing rules within 60 days of hire.
<br>Makes necessary adjustments as required by plan reimbursement.
<br>Duties performed may include one or more of the following core functions: (a) Directly interacting with or caring for patients; (b) Directly interacting with or caring for human-subjects research participants; (c) Regularly maintaining, modifying, releasing or similarly affecting patient records (including patient financial records); or (d) Regularly maintaining, modifying, releasing or similarly affecting human-subjects research records.
<br>Performs other duties as assigned.
<br>SECURITY AND EEO STATEMENT
<br><br>
Security
<br>This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.
<br><br>
EEO
<br>UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.

Clinical Denial Management Specialist II

Minnesota Mental Health Clinics

<div><p><b>Job Title:</b> Billing Specialist<br>
<b>Company:</b> MMHC (Minnesota Mental Health Clinics)</p>
<p><b>
Position Overview</b><br>
Minnesota Mental Health Clinics (MMHC) is seeking a detail-oriented Billing Specialist to support our revenue cycle operations within a behavioral health setting. This role is primarily focused on denial management and resolving outstanding claims to ensure timely and accurate reimbursement.</p>
<p>
The ideal candidate brings experience in healthcare billing (behavioral health preferred) and is comfortable navigating billing platforms such as NextGen or Netsmart. This is a great opportunity for someone who enjoys problem-solving, working independently, and contributing to the financial health of a growing organization.</p>
<p><b>
Key Responsibilities</b></p>
<ul>
<li>Manage and resolve denied claims in a timely and efficient manner</li>
<li>Investigate claim denials, identify root causes, and implement corrective actions</li>
<li>Follow up on outstanding insurance claims to ensure prompt reimbursement</li>
<li>Submit corrected claims and appeals as needed</li>
<li>Collaborate with internal teams to resolve billing discrepancies</li>
<li>Maintain accurate documentation of billing activity and claim status</li>
<li>Ensure compliance with payer requirements and healthcare regulations</li>
</ul>
<p><b>Qualifications</b></p>
<ul>
<li>Previous experience in medical billing required; behavioral health experience preferred</li>
<li>Familiarity with denial management and claims resolution processes</li>
<li>Experience with NextGen and/or Netsmart systems preferred</li>
<li>Strong attention to detail and problem-solving skills</li>
<li>Excellent organizational and time management abilities</li>
<li>Ability to work both independently and collaboratively</li>
</ul>
<p><b>Preferred Skills</b></p>
<ul>
<li>Knowledge of insurance guidelines, including Medicare, Medicaid, and commercial payers</li>
<li>Strong communication skills for payer follow-up and internal coordination</li>
<li>Proficiency with EHR and billing systems</li>
</ul>
<p><b>Compensation &amp; Work Arrangement</b></p>
<ul>
<li>Hourly pay up to $28/hour, depending on experience</li>
<li>Flexible work options: on-site, hybrid, or fully remote</li>
</ul>
<p><b>Benefits</b></p>
<ul>
<li>Healthcare insurance including Medical and Dental.</li>
<li>401K and Roth IRA Retirement Match.</li>
<li>Paid Time Off.</li></ul></div>

Billing Specialist

HRMD Solutions

<p><b>IMPORTANT: Please read before applying</b></p><p>✅ <b>ONLY candidates with AR/ collections or Medical Billing will be considered.</b></p><p>❌ <b>Applicants without relevant healthcare experience (e.g., teaching, engineering, IT, sales, etc.) will be automatically rejected.</b></p><p>Job Description:</p><p>The AR Follow up Specialist will play a critical role in managing and collecting outstanding accounts receivable within the revenue cycle management process. This position requires fluency in English to effectively communicate with our diverse client base. The ideal candidate will have a strong background in collections within the healthcare industry in USA, exceptional communication skills, and the ability to work independently in a fast-paced environment.</p><ul><li><i><b>Full on site in Gulberg 3, Lahore</b></i></li><li><i><b>Night shifts only 6 pm- 3 am</b></i></li></ul><p>Key Responsibilities:</p><ul><li>Check eligibility and benefit verification by calls and web portals.</li><li>Review and verify medical codes, including CPT, ICD-10, and HCPCS.</li><li>Review and transmit corrected claims electronically or by paper according to the payers requirements.</li><li>Monitor and follow on unpaid or denied claims to ensure timely resolution.</li><li>Contact insurance companies to inquire about claims status and facilitate payment.</li><li>Review aging reports regularly to prioritize and address delinquent accounts.</li><li>Initiate apples, for denied or underpaid claims and track the appeal process.</li><li>Develop and implement denial management strategies to minimize future denials.</li><li>Main up-to-date documentation and detailed records of appeals.</li><li>Strong understanding of insurance policies, reimbursement methodologies and billing guidelines.</li><li>Collaborate with billing and coding teams to address recurring issues.</li><li>Investigate and resolve any discrepancies in payments, adjustments, or denials.</li><li>Identify claim processing issues and general billing trends.</li></ul><p>Qualifications:</p><ul><li>Bachelor&rsquo;s Degree from any reputed institute or University.</li><li>1 to 2 years&rsquo; Experience in Medical Billing- Accounts receivable and denial management.</li><li>Knowledge and understanding of USA health insurance guidelines especially Medicare and state Medicaid</li><li>Experience to work on Pain Management, Anesthesia, Psych/ TMS, RTM, CCM.</li></ul><p>Job Type: Full-time</p><p>Job Type: Full-time</p><p>Pay: Rs85,000.00 - Rs125,000.00 per month</p><p>Application Question(s):</p><ul><li>Do you live in lahore?</li><li>Are you willing to work night shift (On-site)?</li></ul><p>Work Location: In person</p>

AR Specialist

Ensemble Health Partners

<div><div>Thank you for considering a career at Ensemble!</div><div></div><div>
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.</div><div></div><div>
Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!</div><div></div><div>
O.N.E Purpose:</div><ul><li><div>
Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.</div></li><li><div>
Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.</div></li><li><div>
Striving for Excellence: Execute at a high level by demonstrating our &ldquo;Best in KLAS&rdquo; Ensemble Difference Principles and consistently delivering outstanding results.</div></li></ul><div></div><div>
The Opportunity:</div><div></div><div>
CAREER OPPORTUNITY OFFERING:</div><ul><li>
Bonus Incentives</li><li>
Paid Certifications</li><li>
Tuition Reimbursement</li><li>
Comprehensive Benefits</li><li>
Career Advancement</li></ul><div></div><div>
The salary range for this position is $69,000.00 to $104,100.00. Final offers are based on experience and geo zone.</div><div></div><div>
The Denial Prevention Process Improvement Advisor leads the performance of deep dive analysis on clinical and technical denials for his or her respective client, utilizing multiple analytics tools (including parsed 835 data, Epic BDC records, Access databases/SQL) to identify patterns and trends relative to acute denials. The Denial Prevention Process Improvement Advisor applies high level problem-solving skills to perform root cause analysis on denied accounts as transactions and extrapolates those causes across large volumes identified as denial trends for assigned facilities. The Denial Prevention Process Improvement Advisor then uses process improvement expertise and persuasion skills to guide and influence subject matter experts through assessments of operations and preparation of policies, procedures, and tip sheets that assist in remedying the root cause(s). The Denial Prevention Process Improvement Advisor is client-facing and oversees completion of denial prevention committee reports and summaries for assigned hospitals, attends monthly denial prevention committee meetings, liaises as primary contact for assigned client on revenue cycle related-denials issues, establishes and maintains client relationships to drive best practice implementations, and utilizes sound judgment and experience to aggregate and advance team recommendations for correcting underlying issues impacting denials. This is done in facilitation and addition to an expectation of contributing to the overarching goals of the Payment Integrity Team and Ensemble as a whole.</div><div></div><div>
Essential Job Functions:</div><ul><li>
Provides relevant guidance and works to resolve issues escalated by Revenue Cycle Site Directors, and other participants related to denial prevention</li></ul><ul><li>
Leads monthly Denial Prevention onsite week kick-off and close-out meetings with assigned client leadership, covering necessary information relative to identified trends, progress from prior actions, and next steps.</li></ul><ul><li>
Establishing strong relationships with appropriate stakeholders/committee members, including Finance Leadership, Revenue Cycle, Managed Care, and hospital ancillary department heads</li></ul><ul><li>
Oversees documentation and trends prevention-related findings into defined templates, initiating or creating reports or summaries as needed.</li></ul><ul><li>
Leads reviews using all patient accounting, host, Epic and related systems used across their client to verify and summarize trends concisely and actionably.</li></ul><ul><li>
Aggregates and provides strategic advisory perspective related to process improvement and quality in assessment of the root cause issues creating denials by working with the subject-matter experts and applicable owners to make recommendations to remedy process, system, and education issues.</li></ul><ul><li>
Creates materials and trains denial prevention staff, revenue cycle site directors, committee members, and revenue cycle staff as necessary on denials-related trends and issues impacting their client.</li></ul><ul><li>
Performs other duties as assigned</li></ul><div></div><div>
Required Minimum Education:</div><div>
4 year/ Bachelors Degree</div><div></div><div>
Specialty/Major:</div><div>
Healthcare administration, Business or related discipline</div><div></div><div>
Preferred Education:</div><div>
Graduate Degree (Masters)</div><div></div><div>
Other Knowledge, Skills and Abilities Required:</div><ul><li>Project Work, Intermediate Excel &amp; Access Skills</li></ul><div></div><ul><li><br>
Project Management, Data Analytics</li></ul><div></div><ul><li>Demonstrated advanced usage of AI and the management of teams using AI to lean in to process and technological improvements, to include the exploration, experimentation, and application of AI.</li></ul><div></div><ul><li>This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.</li></ul><div></div><div>
Licensure/Certification Preferred:</div><ul><li>Certified Specialist Managed Care (CSMC); LEAN Six Sigma Black Belt</li><li>Certified Revenue Cycle Representative: (CRCR)</li></ul><div></div><div>
Join an award-winning company</div><div></div><div>
Five-time winner of &ldquo;Best in KLAS&rdquo; 2020-2022, 2024-2025</div><div>
Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024</div><div>
22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024</div><div>
Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024</div><div>
Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023</div><div>
Energage Top Workplaces USA 2022-2024</div><div>
Fortune Media Best Workplaces in Healthcare 2024</div><div>
Monster Top Workplace for Remote Work 2024</div><div>
Great Place to Work certified 2023-2024</div><ul><li><div>
Innovation</div></li><li><div>
Work-Life Flexibility</div></li><li><div>
Leadership</div></li><li><div>
Purpose + Values</div></li></ul><div></div><div>
Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:</div><ul><li><div>
Associate Benefits &ndash; We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.</div></li><li><div>
Our Culture &ndash; Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.</div></li><li><div>
Growth &ndash; We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.</div></li><li><div>
Recognition &ndash; We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.</div></li></ul><div></div><div>
Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.</div><div></div><div>
Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact <div>TA@ensemblehp.com</div>.</div><div></div><div>
This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role&rsquo;s range.</div><div></div><div><div>
EEOC &ndash; Know Your Rights</div><br>
<div>FMLA Rights - English</div></div><div><div>
La FMLA Espa&ntilde;ol</div></div><div><div>
E-Verify Participating Employer</div> (English and Spanish)</div><div><div>
Know your Rights</div></div></div>

Senior Denial Prevention Process Improvement Advisor

Growth Ortho

<div><p><b>Revenue Cycle Reimbursement Specialist</b></p><p></p><p><b><br>
Position Overview:</b><br>
Reporting to the Director of Reimbursement, the Revenue Cycle Specialist is responsible for managing and resolving outstanding claims to achieve maximum reimbursement. This role requires strong knowledge of medical collections, accounts receivable, insurance billing and verification, denial management, appeal submission, and EOB review.</p><p></p><p><b><br>
Responsibilities:</b></p><ul><li> Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.</li><li> Manage daily work queue to prioritize high dollar claim balances.</li><li> Review &amp; work incoming insurance and patient correspondence including refund requests.</li><li> Send appeals when appropriate or provide the requested medical documentation.</li><li> Ability to review medical documentation to justify medical necessity.</li><li> Review patient balances to ensure accuracy and follow up with patients to obtain payments.</li><li> Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.</li><li> Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.</li><li> Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD&rsquo;s) for claim resolution.</li><li> Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.</li><li> Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.</li></ul><p></p><p><b><br>
Requirements:</b></p><ul><li> 2+ years of ASC and/or orthopedic revenue cycle OR orthopedic collections experience<b>.</b></li><li> Ability to read and interpret insurance explanations of benefits and managed care contracts.</li><li> Must communicate effectively, both verbally and in writing, with internal and external clients.</li><li> Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines</li><li> Knowledge or experience working with a variety of health care insurance payers is preferred</li><li> Intermediate computer proficiency in Microsoft Office including Excel and Outlook</li><li> Greenway Intergy, MedInformatix, and/or Nextgen Practice Management experience a plus but not required.</li><li> High School Diploma or equivalent.</li></ul></div>

Revenue Cycle Reimbursement Specialist

Macrise Tech Solutions

<p>Accounts Receivable &amp; Denial Management</p><ul><li>Monitor and manage outstanding insurance claims to support the reduction of overall Accounts Receivable (AR).</li><li>Perform consistent follow-ups on denied claims to ensure timely resolution and claim recovery.</li><li>Analyze Electronic Remittance Advice (ERA) reports to identify denial trends and recommend corrective actions to prevent recurrence.</li><li>Prepare, submit, and track appeals for denied or underpaid claims while ensuring all required documentation is complete and accurate.</li><li>Investigate payment discrepancies and escalate complex issues to the Billing Manager when necessary.</li><li>Maintain updated AR aging reports and provide regular weekly and monthly performance summaries.</li><li>Handle billing and claim management for specialized services such as TMS, Spravato, and psychological assessments.</li><li>Work collaboratively with the Billing Manager to achieve AR reduction, recovery, and billing accuracy objectives.</li></ul><p>Patient &amp; Provider Communication</p><ul><li>Respond promptly and professionally to billing-related inquiries from patients, providers, and internal teams.</li><li>Review and verify patient account details to ensure accuracy before initiating collections or claim follow-ups.</li><li>Coordinate with healthcare providers to resolve claim issues related to coding errors or missing documentation.</li><li>Communicate with insurance payers to address eligibility verification, prior authorization requirements, and network participation matters.</li><li>Address patient billing concerns with professionalism and empathy, including processing refunds when applicable.</li></ul><p>Systems Management &amp; Process Improvement</p><ul><li>Create, monitor, and resolve billing-related support tickets within the eClinicalWorks (eCW) system.</li><li>Provide guidance and support to team members on AR follow-up strategies and denial management procedures.</li><li>Coordinate with U.S.-based billing teams to facilitate accurate and timely claims submission.</li><li>Participate in operational meetings and performance reviews to evaluate trends and recommend workflow improvements.</li><li>Stay updated on payer guidelines, regulatory requirements, and industry best practices related to medical billing and reimbursement.</li></ul><p>Job Type: Full-time</p><p>Pay: Rs45,000.00 - Rs70,000.00 per month</p><p>Ability to commute/relocate:</p><ul><li>Wapda Town: Reliably commute or planning to relocate before starting work (Required)</li></ul><p>Application Question(s):</p><ul><li>Willing to work the night shift in Wapda Town, Lahore?</li></ul><p>Experience:</p><ul><li>Medical Billing: 1 year (Preferred)</li></ul><p>Language:</p><ul><li>English (Required)</li></ul><p>Work Location: In person</p>

AR & Claims Resolution Specialist

Powerback Rehabilitation

<div>Overview:
<div><b>
FULL-TIME (REMOTE) CORPORATE DENIALS &amp; APPEALS SPECIALIST</b></div><div></div><div><b><br>
MUST HAVE HEALTHCARE BILLING/COLLECTIONS EXPERIENCE W/CONCENTRATION ON DENIALS / APPEALS</b></div><div></div><div><br>
At Powerback, we're on a mission to improve lives. As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay active and thrive while providing essential therapy for children at home and in school.</div><div></div><div><br>
With over 38 years of trusted service, our reach spans skilled nursing centers, assisted and independent living facilities, outpatient clinics, and home-based care. We're proud to deliver personalized care exactly where and when it's needed most.</div><div></div><div><br>
Join an industry-leading team that restores hope and makes a lasting impact. If you're passionate about making a meaningful difference and want to be part of the future of rehabilitation and wellness, Powerback is the place for you.</div><div></div><div><b><br>
Why Powerback?</b></div><ul><li><b>
Benefits:</b> We offer Medical, Dental, and Vision plans to Full-Time team members. We offer Dental and Vision to Part-Time team members.</li><li><b>
Paid Time Off</b>: We offer generous paid time off to Full-Time and Part-Time team members.</li><li><b>
Support for New Grads:</b> Our Powerback Clinical Mentorship Program kicks off on day one, helping you learn from the best in the field.</li><li><b>
Continuing Education:</b> Keep growing with free CEUs through Medbridge.</li><li><b>
H-1B Visa &amp; Relocation Assistance:</b> We support Visa or Green Card sponsorships, plus our Journey Travel Program lets you work across the U.S. with the security of a full-time role.</li><li><b>
Perks at Powerback:</b> Enjoy exclusive discounts on Wireless/TV, Home/Auto/Renters and Pet Insurance, Childcare, Eldercare, and more. Earn rewards through our PowerZone Employee Recognition Program, and expand your expertise with our Clinicians in Action professional development program</li></ul>
Responsibilities:
<div><div>The Denials and Appeals Specialist is responsible for the follow up of denied claims from all commercial and contracted payers. The follow up includes initial assessment of the denials received to determine the appropriate process. Once determined, established policy and procedure will be followed for appeal submission.</div><div><br>
Reviews assigned accounts that have a payer denial based on the response from the payer and takes appropriate action, including appeals, based on the type of denial.</div><div>
Documents all necessary elements; reason for denial/audit, denial status, and action taken in the electronic medical record per denial management policy.</div><div>
Provides missing or additional information if necessary, to expedite the resolution of the denied claim. This may include writing detailed appeal letters supporting the claim and reimbursement.</div><div>
Performs all appeals and denials recovery procedures needed to appropriately and accurately resolve denied claims. This includes working with internal and external customers.</div><div>
Consistently meets productivity and quality standards established by management, recommending new approaches for enhancing performance and productivity when appropriate.</div><div>
Keeps Supervisor/Manager informed of any problems or issues related to the appeal process and/or current appeals.</div><div>
Performs other duties as assigned.</div></div>
Qualifications:
<div><ul><li>High School diploma or equivalent education and experience required. College degree preferred.</li><li>Must be proficient using MS Office or Google Suite applications.</li><li>Strong analytical skills.</li><li>Minimum of 1 - 2 years of previous revenue cycle management experience.</li></ul></div>
Posted Salary Range: USD $20.00 - USD $20.00 /Hr.</div>

Denials and Appeals Specialist

Search 10000+ Denial management specialist jobs near you this March. New roles added regularly across leading industries. Apply today.