Denials Specialist

Denials Specialist

Job Summary:

We are looking for a dedicated Denials Specialist to join our team. The Denials Specialist will be responsible for identifying and appealing denied claims, analyzing data to determine root causes of denials, and implementing processes to reduce denials. The ideal candidate should demonstrate excellent problem-solving and communication skills, as well as a strong understanding of healthcare claims processing.

Responsibilities:

• Monitor and track denied claims on a daily basis, identify root causes and appeal denied claims.

• Analyze data to measure trends in denials and recommend and implement process changes to address them.

• Collaborate with other staff to ensure accurate and timely claims submission.

• Participate in meetings with payers regarding denials and appeal strategies.

• Develop and maintain relationships with payers and other external stakeholders.

• Assist in researching and resolving detailed inquiries from payers.

• Participate in training and ongoing education initiatives.

• Maintain up-to-date knowledge of insurance carrier regulations and reimbursement practices.

Requirements:

• Bachelor’s degree in healthcare, business, or related field.

• Minimum of 3 years’ experience in healthcare revenue cycle management.

• Knowledge of CPT, ICD-10, and HCPCS coding.

• Experience with claim denials, appeals, and other revenue cycle processes.

• Excellent problem-solving and communication skills.

•Ability to work independently and as part of a team.

•Strong attention to detail and organizational skills.