denials specialist

Rochester Regional Health

<div><p><b>Job Title: </b>Medical Billing &amp; Denials Specialist<br>
<b>Department:</b> Patient Financial Services<br>
<b>Location: SLH - </b>Regional Administrative Campus<br>
<b>Hours Per Week: </b>37.5<br>
<b>Schedule: </b>8am-4pm</p><p></p><p><b><br>
SUMMARY:</b></p><p><b>
</b> A Medical Billing and Denials Specialist is responsible for managing the billing process, submitting claims to insurance companies, following up on unpaid or denied claims, and ensuring timely reimbursement for healthcare services. This role plays a critical part in the revenue cycle management of the healthcare organization by identifying trends in denials and taking corrective actions.</p><p></p><p><b>
RESPONSIBILITIES:</b></p><ul><li><p><b>
Medical Billing &amp; Claims Management</b>: Submit and track insurance claims, resolve denials and billing edits, process remittances and adjustments, and ensure timely and accurate account resolution in line with payer requirements.</p></li><li><p><b>
Appeals &amp; Reimbursement Review</b>: Conduct detailed reviews of denied or underpaid claims, prepare appeal letters, gather supporting documentation, and collaborate across departments to ensure successful claim outcomes.</p></li><li><p><b>
Customer Service &amp; Communication</b>: Respond to patient inquiries, verify insurance eligibility and authorizations, and maintain thorough documentation while ensuring clear communication across Revenue Cycle teams.</p></li><li><p><b>
Compliance &amp; Operational Excellence</b>: Maintain HIPAA confidentiality, meet productivity benchmarks, stay current with billing policies, and manage workload with strong time management, organization, and communication skills.</p></li></ul><p></p><p><b><br>
PREFERRED QUALIFICATIONS:</b></p><ul><li><p>
High school graduate or equivalent</p></li><li><p>
Bachelor&rsquo;s degree in healthcare or business administration</p></li><li><p>
Minimum 1 year medical billing and denials, customer service and relevant finance experience in a health care organization a plus
</p></li><li><p>Certification in medical billing
</p></li></ul><p></p><p><b>UNION:</b></p>
1199-200B Clerical Workers (CPH)<p><i>
Note: </i><i>Not all per diem roles are union eligible</i></p><p></p><p><b>
EDUCATION:</b></p><p></p><p><b>
LICENSES / </b><b>CERTIFICATIONS:</b></p><p></p><p><b>
PHYSICAL REQUIREMENTS:</b></p>
S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.<p></p><p><b>
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.</b><b>
</b></p><p></p><p><b>Any physical requirements reported by a prospective employee and/or employee&rsquo;s physician or delegate will be considered for accommodations.
</b></p><p></p><p><b>PAY RANGE:</b></p>
$20.66 - $29.99<p></p><p><i>
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.</i><b>
</b></p><p></p><p><b>Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.</b></p></div>

Medical Billing & Denials Specialist

<div><p><b>Job Title: </b>Medical Billing and Denials Specialist<br>
<b>Department</b>: Revenue Cycle<br>
<b>Location:</b> SLH Regional Administrative Campus 6196 US 11 Canton, NY<br>
<b>Hours Per Week</b>: 37.5<br>
<b>Schedule: </b>Monday<b> </b>- Friday 8 am - 4pm</p><p></p><p><b><br>
SUMMARY:</b></p><p><b>
</b> A Medical Billing and Denials Specialist is responsible for managing the billing process, submitting claims to insurance companies, following up on unpaid or denied claims, and ensuring timely reimbursement for healthcare services. This role plays a critical part in the revenue cycle management of the healthcare organization by identifying trends in denials and taking corrective actions.</p><p></p><p><b>
RESPONSIBILITIES:</b></p><ul><li><p><b>
Medical Billing &amp; Claims Management</b>: Submit and track insurance claims, resolve denials and billing edits, process remittances and adjustments, and ensure timely and accurate account resolution in line with payer requirements.</p></li><li><p><b>
Appeals &amp; Reimbursement Review</b>: Conduct detailed reviews of denied or underpaid claims, prepare appeal letters, gather supporting documentation, and collaborate across departments to ensure successful claim outcomes.</p></li><li><p><b>
Customer Service &amp; Communication</b>: Respond to patient inquiries, verify insurance eligibility and authorizations, and maintain thorough documentation while ensuring clear communication across Revenue Cycle teams.</p></li><li><p><b>
Compliance &amp; Operational Excellence</b>: Maintain HIPAA confidentiality, meet productivity benchmarks, stay current with billing policies, and manage workload with strong time management, organization, and communication skills.</p></li></ul><p></p><p><b>
REQUIRED QUALIFICATIONS: </b>None</p><p></p><p><b><br>
PREFERRED QUALIFICATIONS:</b></p><ul><li><p>
High school graduate or equivalent</p></li><li><p>
Bachelor&rsquo;s degree in healthcare or business administration</p></li><li><p>
Minimum 1 year medical billing and denials, customer service and relevant finance experience in a health care organization a plus
</p></li><li><p>Certification in medical billing
</p></li></ul><p></p><p><b>UNION:</b></p>
1199-200B Clerical Workers (CPH)<p><i>
Note: </i><i>Not all per diem roles are union eligible</i></p><p></p><p><b>
EDUCATION:</b></p><p></p><p><b>
LICENSES / </b><b>CERTIFICATIONS:</b></p><p></p><p><b>
PHYSICAL REQUIREMENTS:</b></p>
S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.<p></p><p><b>
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.</b><b>
</b></p><p></p><p><b>Any physical requirements reported by a prospective employee and/or employee&rsquo;s physician or delegate will be considered for accommodations.
</b></p><p></p><p><b>PAY RANGE:</b></p>
$20.66 - $29.99<p></p><p><i>
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.</i><b>
</b></p><p></p><p><b>Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.</b></p></div>

Collections & Denials Management Representative

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

Aspirion

<div>Description:
<p>
For over two decades, Aspirion has delivered market-leading revenue cycle services. We specialize in collecting challenging payments from third-party payers, focusing on complex denials, aged accounts receivables, motor vehicle accident, workers&rsquo; compensation, Veterans Affairs, and out-of-state Medicaid.</p><p>
At the core of our success is our highly valued team of over 1,400 teammates as reflected in one of our core guiding principles, &ldquo;Our teammates are the foundation of our success.&rdquo; United by a shared commitment to client excellence, we focus on achieving outstanding outcomes for our clients, aiming to consistently provide the highest revenue yield in the shortest possible time.</p><p>
We are committed to creating a results-oriented work environment that is both challenging and rewarding, fostering flexibility, and encouraging personal and professional growth. Joining Aspirion means becoming a part of an industry leading team, where you will have the opportunity to engage with innovative technology, collaborate with a diverse and talented team, and contribute to the success of our hospital and health system partners. Aspirion maintains a strong partnership with Linden Capital Partners, serving as our trusted private equity sponsor.</p><p>
We are seeking an Appeals Specialist to join our growing team. As an Appeals Specialist, you will contribute to our fast-paced, collaborative environment and will bring your expertise to deliver exceptional billing services for our clients. The ideal candidate will have strong technical skills, excellent communication and healthcare experience in a hospital and a professional billing or coding environment. A successful Appeals Specialist must be able to perform each responsibility satisfactorily. The following responsibilities represent the strong knowledge, skills and abilities required to perform the job successfully and independently.
 </p><p><b>Key Responsibilities</b></p><ul><li>
Review/work denials from an explanation of benefits (EOB) statement</li><li>
Analyze A/R (Accounts Receivable) reports to follow up on unpaid claims</li><li>
Compose and submit appeals to insurance companies</li><li>
Submit required documentation to insurance companies as requested</li><li>
Research claims for information to process bills in a timely manner</li><li>
Communicate with insurance companies, adjustors and patients on a regular basis</li><li>
Correct errors and resubmit all unprocessed or returned claims to insurance companies</li><li>
Correct UB04 and HCFA bills</li><li>
Maintain productivity standards</li><li>
Perform other duties as assigned by Direct Report
</li></ul>Requirements:
<ul><li>2+ years of healthcare billing and denials experience</li><li>
Strong healthcare industry knowledge including basic coding principals</li><li>
Demonstrated ability to troubleshoot and remedy claims denials or submission errors</li><li>
Demonstrated ability to interpret claims data in internal billing software and diverse EHR&rsquo;s</li><li>
Prior experience using Microsoft Office Suite</li></ul><p><b>
Education and Experience</b></p><ul><li>
High School Diploma or GED required; bachelor's degree preferred</li><li>
Previous work from home experience</li></ul><p><b>
Benefits</b></p><p>
At Aspirion we invest in our employees by offering a full benefits package, including health, dental, vision and life insurance upon hire, matching 401k, competitive salaries, advancement opportunities, and incentive programs.</p><p>
The US base pay range for this position <b><i>starts</i></b> at $19.00 hourly. <i>Individual pay is determined by a number of factors including, but not limited to, job-related skills, experience, education, training, licensure or certifications obtained. Market, location and organizational factors are also considered.</i> In addition to base salary, a competitive benefits package is offered.</p><p><b>
AAP/EEO Statement</b></p><p>
Equal Opportunity Employer/Drug-Free Workplace: Aspirion is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, pregnancy, religion, national origin, ancestry, medical condition, marital status, gender identity citizenship status, veteran status, disability, or veteran status. Aspirion has a Drug-Free Workplace Policy in effect that is strictly adhered to.</p><p>
Please note that this position is contingent upon the successful completion of a pre-employment drug screening and background check. These steps are part of our standard hiring process to ensure a safe and compliant workplace.</p></div>

Appeals Specialist - Hospital Billing, AR

Nobox Idea

<p>We are looking for a highly motivated and detail-oriented <b>AR Executive</b> to join our US Medical Billing team. The ideal candidate will be responsible for managing accounts receivable, insurance follow-ups, denial resolution, and ensuring timely reimbursement from US insurance payers.</p><p><b>Key Responsibilities:</b></p><ul><li>Follow up with US insurance companies regarding unpaid claims</li><li>Analyze and resolve claim denials</li><li>Work on aging reports and payment posting issues</li><li>Maintain accurate documentation of account activities</li><li>Ensure timely collection of outstanding balances</li></ul><p><b>Requirements:</b></p><ul><li>Experience in US Medical Billing (AR / Denials / Insurance Follow-ups)</li><li>Good communication skills in English</li><li>Knowledge of medical billing software and insurance portals</li><li>Ability to work in a fast-paced environment</li></ul><p>Work Location: In person</p>

AR EXECUTIVE

UNM Hospital

<div><p>The UNM Medical Group, Inc. is hiring for an <b>Account Operations Tech 3</b> to join our <b>AR &amp; Denials</b> department. This opportunity is a full-time day shift opening located in Albuquerque, New Mexico. Hybrid position-selected candidate must have a permanent address and live in New Mexico or be willing to relocate to New Mexico.</p>
<p><b>Minimum $41,305 - Midpoint $51,621*</b></p>
<ul><li>Salary is determined based on years of total relevant experience.</li></ul>
<ul><li>Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE.</li></ul>
<p>Summary</p>
<p>Under general supervision, performs a variety of complex functions to resolve involved billing problems and issues, and maintains appropriate ledgers. Researches and provides reports on resolved invoices. Performs complex analyses of patient accounts, patient payments, and remittance advices from third party payers; posts complex account adjustment, transfers, and other actions. Initiates correspondence to responsible parties or third party payers, as applicable. Provides day-to-day guidance and mentorship to lower level Patient Accounts Techs, as appropriate.</p>
<p>Minimum Job Requirements of an <b>Account Operations Tech 3:</b></p>
<p>High school diploma or GED with at least 5 years of experience that is directly related to the duties and responsibilities specified<i>. </i>Completed degree from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis. <i>Verification of education and licensure (if applicable) will be required if selected for hire.</i></p>
<p>Duties and Responsibilities of an <b>Account Operations Tech 3:</b></p>
<div><ul><li>Analyzes and investigates reimbursements from third party payors, such as Medicare, Champus, Medicaid, Salud, HMO's, and other payors, to determine if contracted amount has been allowed; researches and analyzes third party payor remittance documentation to determine priority of payment and application of adjustments.</li></ul>
<ul><li>Reconciles and applies changes to patient invoices and account to correct account issues; initiates inquiries, either by phone or in writing, to third party payors, and/or patients to resolve reimbursement and credit balance issues.</li></ul>
<ul><li>Responds to requests from third party payors and/or patients regarding reimbursement problems and issues.</li></ul>
<ul><li>Interacts with and advises internal staff regarding billing and documentation policies, procedures, and serves as liaison with other department representatives to resolve reimbursement and/or credit balance issues.</li></ul>
<ul><li>Prepares adjustment and refund request forms.</li></ul>
<ul><li>Collects, analyzes, and summarizes data for preparation of statistical reports; creates and maintains specified data files and logs, maintains computerized systems for collection and tracking of data, and assists in the preparation of reports.</li></ul>
<ul><li>Ensures strict confidentiality of patient medical and financial records, in compliance with federal and state patient privacy legislation.</li></ul>
<ul><li>Assists in departmental problem solving, project planning, and the development and execution of departmental goals and objectives.</li></ul>
<ul><li>May provide task-specific support and guidance to other techs, as appropriate.</li></ul>
</div>
<p><b>Why Join UNM Medical Group, Inc.?</b></p>
<p>Since our creation in 2007, our dynamic organization has continued to grow and form strong partnerships within the UNM Health system. <b>Modern Healthcare recognizes UNMMG in their Best Places to Work recognition for 2025</b>. We <b>ASPIRE</b> to incorporate the following values into all aspects of our culture and work: we always demonstrate an <b>Attitude</b> of <b>Service</b> with <b>Positivity</b>, <b>Integrity</b> and <b>Respect</b> as we strive for <b>Excellence</b>. We are dedicated to embracing and promoting diversity while fostering well-being across New Mexico through cultural humility and respect for everyone.</p>
<p><b>Benefits:</b></p>
<ul><li><b>Competitive Salary &amp; Benefits</b>: UNMMG provides a competitive salary along with a comprehensive benefits package.</li>
<li><b>Insurance Coverage</b>: Includes medical, dental, vision, and life insurance.</li>
<li><b>Additional Perks</b>: Offers tuition reimbursement, generous paid time off, and a 403b retirement plan for eligible employees.</li>
</ul>
<p>Apply to our <b>Account Operations Tech 3 </b>opportunity with UNM Medical Group, Inc. and a recruiter will contact you shortly!</p></div>

Account Operations Tech 3

Cook Children's Health Care System

<div><div>Location:</div><div></div>
Calmont Operations Building<div></div><div>
Department:</div><div></div>
CBO/PT Financial Services<div></div><div>
Shift:</div>
First Shift (United States of America)<div></div><div>
Standard Weekly Hours:</div><div></div>
40<div></div><div>
Summary:</div><div></div><div>
The Account Specialist II, Insurance Follow-Up &amp; Denials Management is responsible for all insurance follow-up responsibilities for Cook Childrens Physician Network. Primary duties are; follow-up, analysis, and resolution of outstanding insurance claims; initiation of the appeals process on behalf of CCPN providers. The Account Specialist II, Insurance Follow-Up &amp; Denials Management will primarily be responsible for performing duties such as; reimbursement analysis; provides the Manager, Insurance Follow-Up &amp; Denials Management with timely financial and volume data related to claims adjudication and payment trend analyses; performs all required patient account adjustments; provides feedback to practice managers regarding effectiveness of diagnostic and procedural coding; monitors active accounts receivable for identification of potential problems; serves as liaison between assigned practice(s) and billing office; communicates effectively with patients, practice managers, physicians and others regarding collection of outstanding claims; maintains proper documentation and edits of work performed; and at all times maintains a professional demeanor to assure that patients are treated in an appropriate and compassionate manner.<br>
<br>
Qualifications:</div><ul><li><div>
High School or equivalent required</div></li><li><div>
Intermediate knowledge of coding and medical terminology with understanding of diversified health insurance plans a plus</div></li><li><div>
At least 3 years experience in a physician billing environment or at least two (2) years in the capacity of PN Account Specialist I, with proficiency in performance of duties evidenced by a minimum rating of meets expectations on the most recent Performance Review</div></li><li><div>
Understanding of managed care contracts, denials and payor methodology</div></li><li><div>
Extensive knowledge of healthcare third party reimbursement, variance and denial records</div></li><li><div>
Effective oral and written communication skills</div></li><li><div>
Medical terminology preferred</div></li><li><div>
Prior experience with Epic Resolute Professional Billing preferred</div></li></ul><div></div><div>
About Cook Children&rsquo;s:</div><div></div><div>
Our not-for-profit organization is comprised of a flagship medical center in Fort Worth, Texas, a new medical center in Prosper, Texas, a physician network, home health company, surgery centers, health plan, health services, and health foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet the unique needs of their child. Cook Children's is honored to continually receive recognition for our outstanding efforts and outcomes in pediatric health care.</div><div></div><div>
At Cook Children's, we're more than a health care system&ndash;&ndash;we're your friends, neighbors and even family members. And we're parents too, so we can see the world through your eyes. We see what you're going through&ndash;&ndash;and how we can help you and your child get the best care and support possible.</div><div></div><div><br>
Cook Children&rsquo;s is an equal opportunity employer. As such, Cook Children&rsquo;s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.</div></div>

PN Account Specialist II

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