Denials Specialist

Job Summary

A company is looking for a Denials Specialist- remote.

Key Responsibilities

• Validate denial reasons and ensure accurate coding in DCM, coordinating with the Clinical Resource Center as needed
• Generate appeals based on dispute reasons and payer contract terms, following specific payer guidelines for submission
• Research contract terms and compile necessary documentation for appeals while escalating payment variance trends to leadership

Required Qualifications, Training, and Education

• High School Diploma or equivalent; some college coursework preferred
• 3 - 5 years of experience in a hospital business environment focusing on billing and/or collections
• Intermediate understanding of Explanation of Benefits (EOB), Managed Care Contracts, and hospital billing form requirements (UB-04)
• Intermediate knowledge of ICD-9, HCPCS/CPT coding, and medical terminology
• Intermediate Microsoft Office skills, particularly in Word and Excel