Denials Specialist

Job Summary

A company is looking for a Denials Specialist responsible for managing claims disputes and appeals.

Key Responsibilities

• Validate denial reasons and ensure accurate coding in the DCM system
• Generate appeals based on dispute reasons and payer contract terms
• Research contract terms and compile documentation for appeals

Required Qualifications

• 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) and Managed Care Contracts
• Intermediate knowledge of hospital billing form requirements (UB-04)
• Intermediate understanding of ICD-9, HCPCS/CPT coding, and medical terminology