Denials Management and Claims Resolution

• High School Diploma required.
• Minimum of two (2) years of experience in medical billing, collections, denial management, or claims resolution.
• Experience with insurance appeals, denial management, and payer follow-up required.
• Knowledge of Medicare, Medicaid, and commercial insurance billing guidelines.
• Bilingual English/Spanish preferred; must be able to read, write, and speak English.
• Basic computer knowledge including Microsoft Word, Excel, Electronic Health Records (EHR), billing software, payer portals, email, and e-fax systems.

• CPC preferred 

• In-depth knowledge of CPT, ICD-10, HCPCS, CMS-1500 claim forms, medical terminology, and payer billing requirements.
• Strong understanding of denial management, claims resolution, reimbursement methodologies, and insurance appeals.
• Knowledge of Medicare, Medicaid, and commercial payer policies.
• Excellent analytical and problem-solving skills.
• Strong organizational skills with the ability to prioritize multiple accounts and meet appeal deadlines.
• Excellent written and verbal communication skills.
• Ability to work independently with minimal supervision.
• Ability to maintain patient confidentiality and comply with HIPAA regulations.
• Demonstrates proficiency in Electronic Health Records (EHR), billing software, Microsoft Office, and payer portals.
• Must be dependable, detail-oriented, and able to follow company policies and procedures.

• Investigate, analyze, and resolve denied, rejected, and underpaid insurance claims. 
• Prepare, submit, and track first-level and subsequent insurance appeals within payer deadlines. 
• Review medical records, coding, documentation, and billing information to determine the cause of claim denials. 
• Identify denial trends and recommend corrective actions to reduce future denials and improve reimbursement. 
• Communicate with insurance companies to resolve claim payment issues and obtain claim status updates. 
• Work collaboratively with providers, coders, billers, and authorization staff to resolve documentation, coding, and billing deficiencies. 
• Request claim adjustments, corrected claims, or reconsiderations as appropriate to resolve outstanding balances. 
• Monitor accounts receivable and prioritize denied claims based on aging and financial impact. 
• Maintain accurate and detailed account notes and documentation within the billing system. 
• Ensure all denial and appeal activities comply with payer guidelines and regulatory requirements. 
• Prepare denial management and appeals activity reports for the Revenue Cycle Manager. 
• Assist with identifying process improvements to enhance claim acceptance rates and reduce reimbursement delays. 
• Perform other duties as assigned by management.

Pre-Employment Requirements

• Successful completion of a criminal background check.
• Successful completion of professional reference checks.

Benefits

We offer a competitive salary and a comprehensive benefits package, including:

• 100% employer-paid employee health insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• 401(k) Retirement Plan
• Paid Time Off (PTO)
• Paid Holidays