revenue cycle management specialist

Meds IT Nexus

Kickstart Your Career as a Verification of Benefits (VOB) Specialist at Meds Nexus Pvt. Ltd.!Are you ready to grow with one of Pakistan&rsquo;s fastest-growing medical billing companies? Meds Nexus Pvt. Ltd., located in the heart of Rawalpindi, is hiring Verification of Benefits (VOB) Specialists to join our dynamic team. If you're passionate about healthcare processes, have sharp attention to detail, and possess excellent spoken English skills, this is your opportunity!Job DescriptionAs a VOB Specialist, your core responsibility will be to verify patients&rsquo; insurance eligibility and benefits before their medical visits. You will play a crucial role in supporting our clients in the U.S. healthcare industry by ensuring accurate and timely benefit verification.Key Responsibilities:<ul><li>Contact U.S.-based insurance companies to verify patient coverage details</li><li>Maintain and track the verification workflow for each patient</li><li>Document call notes with precision and take corrective measures as needed</li><li>Update actions and notes on the client&rsquo;s revenue cycle management (RCM) platform</li><li>Follow client-specific documentation standards and protocols</li><li>Uphold Meds Nexus&rsquo; data protection and information security guidelines</li><li>Demonstrate integrity and adhere to the highest standards of ethical conduct</li></ul>Desired Candidate ProfileWe&rsquo;re looking for someone who is detail-oriented, proactive, and well-versed in U.S. medical billing processes.Requirements:<ul><li>Minimum 2+ years of experience as a VOB Specialist with a medical billing service provider</li><li>Strong knowledge of the U.S. revenue cycle, Eligibility &amp; Benefits Verification, and Prior Authorization</li><li>Ability to understand and apply client-specific business rules</li><li>Skilled in generating reports and maintaining accurate records</li><li>Strong communication skills with a neutral/clear accent</li><li>Graduate degree in any field</li><li>Problem-solving attitude with a willingness to learn and grow</li></ul>Job Rewards and Benefits:<ul><li>Paid Leaves</li><li>HR Bonus</li><li>Inflation Bonus</li><li>MTD (Month-To-Date) Bonus</li><li>Promotion</li><li>Increments</li><li>Medical Coverage</li><li>Leave Encashment</li><li>Contributory Saving Plan (CSP)</li><li>Annual Trip</li><li>Saturday and Sunday Off</li><li>Transportation allowances only for female staff</li><li>Complementary Food (Dinner) &amp; Tea/Green Tea (Two times)</li></ul>Office Timing: 5:30 PM to 2:30 AMWhy Join Meds Nexus?Join our team and become part of a forward-thinking organization that values innovation, promotes continuous learning, and provides real opportunities for career advancement. At Meds Nexus, your hard work is not only appreciated&mdash;it&rsquo;s recognized and rewarded.Apply now and take the next step in your medical billing career with Meds Nexus Pvt. Ltd.!Job Type: Full-timeWork Location: In personJob Type: Full-timeWork Location: In person

VOB Specialist

Unified Women's Healthcare

<div>
 
 Overview
 
 
 
 Unified is a nationwide community of providers, operations specialists and thought leaders who look for the greatest opportunities to impact every woman&rsquo;s health, at every stage of their journeys. We are unparalleled in our scale and ability to adapt to address unmet and underserved needs. Through 815+ clinics, 23 IVF labs, nationwide telehealth capabilities and targeted case management, our 2,700+ independent, affiliated providers deliver comprehensive women&rsquo;s health services and continuously work to implement methods and develop techniques or platforms that improve the healthcare experience. We remain focused on enabling the discovery of new ways for our affiliated providers to deliver the high-quality care experience women deserve, in the ways they most wish to receive it, and collaborate across our community to make our vision a reality.
 
 
 We are action oriented. We strategize, implement and execute &ndash; on behalf of the practices we serve.
 
 
 
 About Our RCM Team
 
 
 
 Are you a specialist in the financial healthcare lifecycle? We are looking for talented professionals to join our Revenue Cycle Management team. By applying to this "Talent Pipeline" requisition, you are expressing interest in multiple current and upcoming roles.
 
 
 
 Choose Your Path
 
 
 
 We are currently sourcing for two primary functional areas. Please indicate your preference in your application:
 
 
 <ul>
 <li>
 Coding Analyst: The Coding Analyst is entrusted with the job of reviewing, auditing and coding provider&rsquo;s documentation for the purpose of reimbursement, training, education and compliance using ICD-10 and CPT codes. The successful applicant will serve as an information resource and guide to our providers, clinical staff, practice managers, members of the Revenue Cycle team and other leadership. This position will be directly involved in analyzing pre-bill claim edits, claim denials and AR management, and working alongside the Revenue Specialists, will review and amend denied claims to ensure accurate coding and adherence to payor policy requirements. The Coding Analyst will assist the Revenue Cycle Manager in proactive audits of medical charts and records for compliance with federal coding regulations and guidelines. This role utilizes knowledge of client systems and procedures to provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. The Coding Analyst reviews, develops, and/or modifies client procedures, systems, and protocols to achieve and maintain compatibility with billing requirements and compliance standards.
 </li>
 <li>
 Medical Coder: This position provides coding services on the inpatient, outpatient, or physician medical records using ICD-10 coding systems to accurately code and bill medical services. He/she serves as an information resource and guide to providers, clinical staff, practice managers, members of the quality assurance team and other leadership. The Medical Coder will be directly involved in claims denial management, working alongside the Revenue Specialists to review and amend denied claims for accurate coding based on physician documentation. The Medical Coder will assist the Compliance Manager in proactive audits of medical charts and records for compliance with federal coding regulations and guidelines. This role uses knowledge of client systems and procedures to provide a second level review of codes assigned to medical diagnoses and clinical procedures, ensuring that medical billing conforms to legal and procedural requirements. The Medical Coder reviews, develops, and/or modifies client procedures, systems, and protocols to achieve and maintain compatibility with billing requirements and compliance standards.
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 While each role has specific needs, these coding professionals share:
 
 
 <ul>
 <li>
 Provide second-level review of billing performances to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices
 </li>
 <li>
 Audit medical record documentation to identify under-coded and over-coded services; prepare reports of findings and meet with providers to provide education and training on accurate coding practices and compliance issues
 </li>
 <li>
 Interact with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtain clarification of conflicting, ambiguous, or non-specific documentation through provider queries
 </li>
 <li>
 Submit any issues or trends found within documentation by a physician and /or physician extender to Revenue Cycle Manager and/or practice administrator
 </li>
 <li>
 Interact with Revenue Specialists and practice billing specialists to ensure appropriate and complete follow-up of patient accounts to maximize reimbursement through AR management processes, including corrections and resubmissions as needed
 </li>
 <li>
 Analyze individual payor performances regarding fee schedule reimbursements and trends
 </li>
 <li>
 Research, analyze, and respond to inquiries regarding compliance, payor policies and guidelines, inappropriate coding, denials, and billable services
 </li>
 <li>
 Monitor and distribute communications regarding payor policy changes and updates, in relation to our provider specialties
 </li>
 <li>
 Provide training, guidance and oversight to staff less experienced in coding guidelines
 </li>
 <li>
 Serve as an information resource and guide to clinicians, champion the need to change coding behaviors and serve as subject matter expert
 </li>
 <li>
 Train, instruct, and provide support to medical providers and practice billing specialists as appropriate regarding coding compliance, documentation, and regulatory provisions, and third-party payor requirements
 </li>
 <li>
 Review, develop, modify, and adapt relevant client procedures, protocols, and data management systems to ensure compliance with organization&rsquo;s policies
 </li>
 <li>
 Interact with providers and management to review and/or implement codes and to update charge documents
 </li>
 <li>
 Illustrate excellent knowledge of healthcare industry regarding the revenue cycle, coding, claims, and state insurance laws
 </li>
 <li>
 Ensure strict confidentiality of financial and medical record
 </li>
 <li>
 Perform miscellaneous job-related duties as assigned
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Certified Professional Coder (CPC) certification required
 </li>
 <li>
 Minimum of 5 years&rsquo; experience as a biller, collector, coder, or back office support staff, or other equivalent medical industry experience
 </li>
 <li>
 OB/GYN experience preferred, but not required
 </li>
 <li>
 Associates degree from an accredited university preferred
 </li>
 <li>
 Knowledge of auditing concepts and principles
 </li>
 <li>
 Advanced knowledge of medical coding and billing systems and regulatory requirements
 </li>
 <li>
 Ability to use independent judgment and to manage and impart confidential information
 </li>
 <li>
 Ability to analyze and solve problems
 </li>
 <li>
 Ability to travel (up to 25%, as needed)
 </li>
 <li>
 Strong communication and interpersonal skills
 </li>
 <li>
 Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation
 </li>
 <li>
 Knowledge of current and developing issues and trends in medical coding procedures requirements
 
 
 </li>
 </ul>
 
 We&rsquo;re here for you&mdash;both personally and professionally.
 
 
 
 Our benefits are designed to support you and your family at every stage of life. From health and wellness to financial security and career growth, we offer a comprehensive package to help you thrive.
 
 
 
 Here&rsquo;s a look at what we offer:
 
 
 
 <ul>
 <li>
 Health Coverage
 
 
 </li>
 </ul>
 Medical, dental, and vision plans, fertility benefits, and supplemental insurance options.
 
 
 <ul>
 <li>
 Paid Time Off
 
 
 </li>
 </ul>
 Vacation, personal days, and paid holidays to help you recharge.
 
 
 <ul>
 <li>
 Financial &amp; Retirement Planning
 
 
 </li>
 </ul>
 401(k) with employer contribution, plus Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs).
 
 
 <ul>
 <li>
 Income Protection
 
 
 </li>
 </ul>
 Short- and long-term disability, paid parental leave, basic life insurance, and optional additional coverage.
 
 
 <ul>
 <li>
 Wellbeing Support
 
 
 </li>
 </ul>
 Employee Assistance Program, commuter benefits, pet insurance, and identity theft protection.
 
 
 <ul>
 <li>
 Professional Development
 
 
 </li>
 </ul>
 Opportunities and resources to support your career growth.
</div>

Medical Claim Coding Talent Pipeline

Tryon Medical Partners

<div><div>Revenue Cycle Account Reimbursement Specialist II<div></div><div>
Job Summary:</div><div>
The Account Reimbursement Specialist I (ARS I) is responsible for accurately processing information to ensure accurate and compliant billing for office and hospital procedures. The Revenue Cycle &ndash; ARS I researches insurance guidelines and focuses on improving the effectiveness of billing processes. The position requires attention to detail, strong organizational skills, and dependability. This role is vital to the overall financial success for the organization. 
 
(This is a full time position that will support our RCM team at SouthPark Monday to Friday, 8 am to 5 pm) 
 
Primary Job Responsibilities:</div><ul><li>
Performs daily billing activities to ensure successful processing and payment of claims.</li><li>
Ensures claim information is complete and accurate for charge entry and data enters key demographic information necessary for insurance claim processing.</li><li>
Verifies all patient benefits, eligibility, and coverage to ensure accurate billing.</li><li>
Audits completeness and accuracy of all claims prior to submission to claims clearinghouse.</li><li>
Make necessary claim corrections to resolve payer claim edits and rejections.</li><li>
Reports billing changes, billing issues, and process improvement plan accomplishments to RCM Leadership.</li><li>
Completes tasks in RCM to resolve patient cases (via phone or written communication), process virtual payments, process insurance refund requests, research missing payments, process bankruptcy and deceased patient notifications, and collection account reconciliation.</li><li>
Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.</li><li>
Performs other duties as required or assigned within the scope of responsibility.</li></ul><div>
Requirements:</div><ul><li>
Minimum of two (2) years of complex claim follow-up experience in a physician office, hospital, ambulatory surgery center or centralized medical business office.</li><li>
Knowledge of medical terminology, ICD-10, and CPT codes.
</li><li>Excellent computer skills; Intermediate skill with Microsoft Word, Outlook, and Excel.
</li><li>Experience working within EMR systems. Experience with AthenaHealth EMR is a plus.
</li></ul><ul><li>Experience interpreting payor explanation of benefits.
</li><li>Excellent verbal communication skills and strong customer-service background.</li><li>
Ability to manage time and organize daily schedule to meet productivity and accuracy standards.</li></ul><div> 
 
 
Education and Certifications:</div><ul><li>
High school diploma or equivalent required.</li><li>
Associate degree in business, healthcare administration or related field highly preferred.
</li></ul><div> 
Physical Requirements:</div><ul><li>
Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.</li><li>
Must be able to lift and support weight of 35 pounds.
</li><li>Ability to concentrate on details.</li><li>
Use of computer for long periods of time.</li></ul></div>
MnRlbldwkI</div>

Account Reimbursement Specialist II

Thathal ITS

Company: Thathal ITSLocation: Rawalpindi / IslamabadWork Model: Hybrid (Remote Monday, Tuesday, Thursday, Friday | On-site Wednesday)Working Hours: US Time Zone (Night Shift in Pakistan)Job Summary We are seeking a detail-oriented Medical Claims Follow-Up Specialist to assist with Revenue Cycle Management (RCM) activities for US healthcare clients.Responsibilities<ul><li>Contact insurance companies to verify claim status and payment information</li><li>Follow up on outstanding and denied medical claims</li><li>Obtain denial reasons and required documentation for claim resolution</li><li>Document call outcomes and update claim notes with accuracy</li><li>Review payer responses and identify next steps for claim processing</li><li>Escalate unresolved issues when necessary</li><li>Maintain productivity targets for claims processed and calls completed</li><li>Coordinate with internal teams regarding claim-related issues</li><li>Ensure compliance with HIPAA and data privacy requirements</li></ul>Requirements<ul><li>Strong spoken and written English communication skills</li><li>Professional communication skills for interacting with insurance representatives</li><li>Strong attention to detail and documentation skills</li><li>Ability to manage multiple claims and follow-up tasks efficiently</li><li>Proficiency with web-based systems, email, and spreadsheets</li><li>Bachelor&rsquo;s degree preferred</li></ul>Preferred Qualifications<ul><li>Experience in medical billing, insurance verification, claims follow-up, or RCM</li><li>Familiarity with Medicare, Medicaid, and commercial insurance payers</li><li>Prior experience working with US healthcare clients</li><li>HIPAA awareness or certification is a plus</li></ul>What We Offer<ul><li>Competitive salary</li><li>Professional training</li><li>Career growth opportunities</li><li>Opportunity to work with US healthcare clients</li></ul>How to ApplySend your CV to hr@thathalits.com and mention &ldquo;Medical Claims Follow-Up Specialist&rdquo; in the subject line.Pay: Rs50,000.00 - Rs70,000.00 per monthWork Location: Hybrid remote in Rawalpindi

Medical Claims Follow-Up Specialist / RCM Associate

Doctors Urgent Care Group

About Us:Doctors Urgent Care Group is a fast-growing, multi-million dollar urgent care corporation operating 31 locations nationwide with over 300 employees across 5 states. We bridge the gap between high-volume clinic demands and seamless technology. We are seeking a highly detail-oriented, accurate, and efficient Medical Biller specializing in Charge Creation to join our collaborative RCM team on-site.We offer competitive compensation ranging from 45K-65K (based directly on experience) along with a comprehensive benefits package including Medical Compensation, Paid Sick Leaves, and Paid Holiday Leaves.Job Summary: The Medical Biller (Charge Creation Specialist) owns the critical front-end data entry and charge capture phase of our revenue cycle. Operating on-site within AdvancedMD, your primary mission is to audit daily clinical encounters and transform medical documentation into accurate, clean claims. This role bridges the gap between what the provider performs in the exam room and what is billed to insurance. You will ensure that proper codes, modifiers, and demographics are entered flawlessly to maximize data compliance and prevent front-end clearinghouse rejections.Core Duties and Responsibilities:Charge Capture &amp; Auditing: Audit daily clinic schedules, logs, and electronic charts against submitted encounters to ensure every single visit has a corresponding charge generated, preventing missing revenue.Encounter Data Entry: Accurately enter and validate patient demographics, insurance details, and clinical encounter metrics within AdvancedMD.Coding &amp; Modifier Verification: Review provider charts to ensure proper quality and alignment of ICD-10 (diagnosis) codes, CPT (procedure) codes, and HCPCS modifiers before final claim processing.Insurance Guideline Review: Verify insurance eligibility, deductibles, co-insurance, and specific regional requirements for Medicare, Medicaid, and commercial payers.Claim Scrubbing Collaboration: Identify, investigate, and resolve front-end data discrepancies, missing signatures, or coding conflicts before claims are batched and submitted.Turnaround Management: Maintain strict adherence to daily and monthly charge entry deadlines to ensure a steady, uninterrupted workflow of outbound billing.Required Skills and QualificationsData-Entry Accuracy: High-speed alphanumeric typing capabilities combined with meticulous attention to detail to minimize keystroke errors.Coding Fundamentals: Strong foundational knowledge of CPT, ICD-10, and HCPCS coding structures, urgent care modifiers, and clinical fee schedules.Payer Guideline Literacy: Strong working knowledge of Medicare, Medicaid, and commercial insurance policies, specifically regarding urgent care deductibles and reimbursement criteria.Analytical Problem-Solving: Ability to cross-reference provider notes with standardized insurance billing rules to spot documentation gaps.Experience and Education RequirementsExperience: Minimum 1+ years of dedicated experience as a Medical Biller with verifiable hands-on experience in charge creation, charge capture, or front-end claim generation. Experience in a high-volume outpatient or urgent care setting is preferred.Software Expertise: Minimum 1+ years of professional hands-on experience using AdvancedMD.Assessment: Must be completely willing to complete an AdvancedMD technical skill test during the interview process.Compliance: Thorough understanding of HIPAA regulations and a strict commitment to maintaining total data privacy.Pay: Rs65,000.00 - Rs100,000.00 per monthWork Location: In person

Medical Biller (Charge Creation)

Octdaily

<div>
 
 We are seeking an experienced
 
 RCM Specialist
 
 with expertise in
 
 Wound Care Medical Billing, Coding Support, Claims Management, and Denial Resolution
 
 . The ideal candidate should have in-depth knowledge of wound care procedures, payer guidelines, medical necessity requirements, and reimbursement processes. The specialist will be responsible for ensuring accurate claim submission, timely reimbursement, and effective denial management while maintaining compliance with payer policies and industry regulations.
 
 
 
 
 
 
 Key Responsibilities
 
 
 
 
 Medical Billing
 
 
 <ul>
 <li>
 Review provider documentation for completeness and billing accuracy.
 </li>
 <li>
 Submit clean claims within established turnaround times.
 </li>
 <li>
 Verify patient demographics, insurance eligibility, and authorization requirements.
 </li>
 <li>
 Ensure proper linkage of ICD-10-CM, CPT, and HCPCS codes.
 </li>
 <li>
 Monitor claim acceptance and resolve clearinghouse rejections promptly.
 </li>
 <li>
 Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
 </li>
 <li>
 Post payments accurately and identify underpayments or payment discrepancies.
 </li>
 <li>
 Follow up on unpaid and partially paid claims until final resolution.
 </li>
 <li>
 Maintain payer-specific billing guidelines and reimbursement updates.
 </li>
 </ul>
 
 
 
 
 
 Wound Care Billing Expertise
 
 
 
 The specialist must have working knowledge of billing and documentation requirements for:
 
 
 
 Debridement Procedures
 
 
 
 
 Skin Substitute and Grafting Procedures
 
 
 
 
 Advanced Wound Care Procedures
 
 
 
 
 
 
 
 Denial Management Responsibilities
 
 
 <ul>
 <li>
 Analyze denied claims to identify the root cause.
 </li>
 <li>
 Resolve coding, billing, and documentation-related denials.
 </li>
 <li>
 Prepare and submit first-level and second-level appeals.
 </li>
 <li>
 Review payer policies and LCD/NCD guidelines.
 </li>
 <li>
 Identify denial trends and recommend preventive actions.
 </li>
 <li>
 Coordinate with providers and coding teams to obtain additional documentation.
 </li>
 <li>
 Track appeal outcomes and maintain denial logs.
 </li>
 <li>
 Reduce denial rates and improve first-pass claim acceptance.
 </li>
 <li>
 Meet established turnaround times for denial resolution.
 </li>
 </ul>
 
 
 
 
 
 Accounts Receivable (AR) Follow-up
 
 
 <ul>
 <li>
 Follow up with commercial, Medicare, Medicaid, and workers' compensation payers.
 </li>
 <li>
 Resolve aging claims across all AR buckets.
 </li>
 <li>
 Identify payment variances and recover underpayments.
 </li>
 <li>
 Escalate high-value accounts when necessary.
 </li>
 <li>
 Maintain productivity and quality standards.
 </li>
 </ul>
 
 
 
 
 
 Required Technical Knowledge
 
 
 
 The candidate should demonstrate proficiency in:
 
 <ul>
 <li>
 ICD-10-CM diagnosis coding
 </li>
 <li>
 CPT and HCPCS procedure coding
 </li>
 <li>
 NCCI edits
 </li>
 <li>
 LCD and NCD coverage policies
 </li>
 <li>
 Medical necessity requirements
 </li>
 <li>
 Modifier usage (e.g., 25, 59, X{EPSU}, JW, JZ, GA, GY, GX, KX)
 </li>
 <li>
 Global surgical package guidelines
 </li>
 <li>
 CMS billing regulations
 </li>
 <li>
 Medicare and commercial payer policies
 </li>
 <li>
 Prior authorization requirements
 </li>
 <li>
 Coordination of Benefits (COB)
 </li>
 <li>
 Appeals and reconsideration processes
 </li>
 <li>
 Claim correction and reopening procedures
 </li>
 </ul>
 
 
 
 
 
 Required Skills
 
 
 <ul>
 <li>
 Strong analytical and problem-solving abilities.
 </li>
 <li>
 Excellent written and verbal communication skills.
 </li>
 <li>
 Attention to detail and high level of accuracy.
 </li>
 <li>
 Ability to manage multiple priorities in a fast-paced environment.
 </li>
 <li>
 Strong understanding of payer reimbursement methodologies.
 </li>
 <li>
 Ability to work independently and collaboratively with clinical and administrative teams.
 </li>
 </ul>
 
 
 
 
 
 Qualifications
 
 
 <ul>
 <li>
 Minimum
 
 3&ndash;5 years of experience
 
 in U.S. medical billing and Revenue Cycle Management.
 </li>
 <li>
 Minimum
 
 2 years of hands-on experience
 
 in wound care billing and denial management.
 </li>
 <li>
 Experience billing Medicare, Medicaid, and commercial insurance plans.
 </li>
 <li>
 Knowledge of wound care reimbursement policies and documentation standards.
 </li>
 <li>
 CPC, COC, or CCS certification is preferred.
 </li>
 <li>
 Associate's or Bachelor's degree in a healthcare-related field is preferred.
 </li>
 </ul>
</div>

RCM Specialist

DCH HEALTH SYSTEM

<div>Overview:
<div>
The Denials and Insurance Follow-Up Specialist is responsible for managing denied claims, following up with insurance payers, and ensuring accurate reimbursement for hospital services. This role is critical to optimizing revenue recovery by investigating, correcting, and resubmitting denied claims while working closely with the Revenue Cycle Management (RCM) team to identify and address patterns in denials. The ideal candidate will have strong analytical skills and experience in medical billing and insurance follow-up, with a focus on reducing accounts receivable days and improving cash flow.</div>
Responsibilities:<div><ul><li> 
Denial Management:</li></ul><ul><li>
Review and analyze denied claims to determine the cause of denial, coordinating with coding, billing, and clinical staff as needed to gather additional information or correct claim errors.</li><li>
Prepare and submit appeal documentation for denied claims, following up with payers to ensure resolution within timely filing limits.</li><li>
Track, document, and report denial reasons, resolution actions, and outcomes, identifying patterns and trends that require additional training or process improvements.</li><li>
Insurance Follow-Up:</li></ul><ul><li>
Conduct timely follow-up on unpaid claims with insurance companies, ensuring that all accounts are resolved or escalated within the hospital&rsquo;s standard timeframes.</li><li>
Verify insurance eligibility and benefits as needed to validate patient coverage and support claims correction or resubmission.</li><li>
Communicate effectively with insurance representatives to resolve outstanding issues, confirm payment status, and clarify discrepancies in payments or coverage.</li><li>
Account Reconciliation and Resolution:</li></ul><ul><li>
Reconcile accounts to ensure payments align with expected reimbursement, identifying and addressing underpayments, overpayments, or unapplied funds.</li><li>
Work closely with the RCM team to adjust accounts, apply payments accurately, and resolve balances on patient accounts after denial or underpayment resolution.</li><li>
Reporting and Analysis:</li></ul><ul><li>
Generate and analyze regular reports on denial rates, follow-up activities, and recovery outcomes to provide insights into common denial reasons and support improvement strategies.</li><li>
Collaborate with management to develop and implement best practices for denial prevention, appeal success rates, and insurance follow-up efficiency.</li></ul></div>
Qualifications:
<h1 class="jobSectionHeader">Qualifications:</h1><ul><li>
Education:</li><li>
High School Diploma or General Education Degree (GED) or 5 years&rsquo; experience in healthcare setting required.</li></ul><ul><li>
Experience:</li><li><ul><li>
Minimum three (3) years&rsquo; experience in medical billing.</li><li>
Prior experience do physician/provider professional fee billing is preferred.
</li><li>Familiarity with payer requirements, denial codes, and appeals processes for a range of insurance plans, including Medicare, Medicaid, and commercial payers.</li></ul></li><li>
Skills and Abilities:</li><li><ul><li>
Strong knowledge of healthcare claims processing, insurance reimbursement, and medical terminology.</li><li>
Proficiency with electronic health record (EHR) and revenue cycle management (RCM) software.</li><li>
Excellent analytical skills with the ability to identify root causes of denials and recommend corrective actions.</li><li>
Detail-oriented with excellent organizational and time management skills, ensuring timely follow-up and adherence to deadlines.</li><li>
Strong verbal and written communication skills, able to effectively interact with insurance</li><li>
Strong communication and interpersonal skills to coordinate effectively with team members and external partners.</li><li>
Able to analyze problems and strategize for better solutions</li><li>
Ability to read and comprehend instructions, short correspondence and memos.
 </li><li>Ability to effectively present information in one on one and small group meetings to clients and staff.
</li><li>Able to Multi-tasking, prioritization, time management and critical thinking skills required.
</li><li>Proficient computer skills, Microsoft Office Suites.
</li><li>Must be able to use personal transportation to provide courier services for the office.
</li></ul></li></ul><div>DCH Standards:</div><ul><li>
Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.</li><li>
Performs compliance requirements as outlined in the Employee Handbook</li><li>
Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.</li></ul><ul><li>
Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.</li><li>
Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.</li><li>
Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.</li></ul><ul><li>
Requires use of electronic mail, time and attendance software, learning management software and intranet.</li><li>
Must adhere to all DCH Health System policies and procedures.</li><li>
All other duties as assigned.</li></ul><div></div><div> 
WORKING CONDITIONS</div> 
Physical presence onsite is essential with possibility of hybrid work schedule. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation.<div>
Valid driver&rsquo;s license and automobile liability insurance. Very good interpersonal communication and customer service skills required. 
</div><div></div><div>Physical: Medium work &ndash; Exerting 20 &ndash; 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to more objects. Physical Demand requirements are in excess of those for Light Work. Good manual and finger dexterity. Ability to tolerate prolonged periods of sitting. Some light driving required.
</div><div>Psychological: Contact with Others, Deal with external customers/clients, sometimes dealing with unpleasant people, occasionally coordinating letters/memos, working with work groups or as a Team constantly/consistently.</div></div>

Denials Specialist II

Search 10000+ Revenue cycle management specialist jobs near you this August. New roles added regularly across leading industries. Apply today.