Job Overview
We are seeking a detail-oriented and proactive Denials Specialist to join our dynamic healthcare team. In this vital role, you will be responsible for reviewing, analyzing, and resolving insurance claim denials to ensure maximum reimbursement for medical services provided. Your expertise in medical coding, billing, and insurance processes will help streamline revenue cycle management and improve overall financial performance. If you thrive in a fast-paced environment and are passionate about accuracy and problem-solving, this is the perfect opportunity to make a meaningful impact in healthcare administration.
Duties
- Review and analyze denied insurance claims to identify reasons for denial and determine appropriate resolution strategies
- Utilize knowledge of DRG (Diagnosis-Related Group), CPT (Current Procedural Terminology) coding, ICD-9, and ICD-10 codes to accurately reprocess claims
- Communicate with insurance companies to appeal denied claims and follow up on outstanding issues
- Collaborate with medical billing teams to correct errors related to medical records, coding inaccuracies, or documentation gaps
- Maintain detailed records of denial reasons, actions taken, and outcomes within electronic health record (EHR) or electronic medical record (EMR) systems
- Stay updated on changes in insurance policies, coding guidelines, and healthcare regulations affecting claim processing
- Assist in training new team members on denial management procedures and best practices
Requirements
- Proven experience in medical coding, billing, or collections within a healthcare setting
- Strong understanding of DRG classifications, CPT coding, ICD-9/ICD-10 coding systems, and medical terminology
- Familiarity with medical records management and insurance claim submission processes
- Experience working with Athena and EPIC EMR/EHR systems.
- Excellent communication skills to liaise effectively with insurance providers and internal teams
- Ability to analyze complex claims data quickly and accurately to resolve denials efficiently
- Prior experience in a medical office environment or healthcare administration is highly preferred
Join us as a Denials Specialist and be part of a dedicated team committed to optimizing revenue cycles while ensuring excellent patient care support. Your expertise will directly contribute to the financial health of our organization and help us deliver exceptional service every day.
Benefits:
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible schedule
- Health insurance
- Life insurance
- Vision insurance
Work Location: In person
