Denials Specialist

Job Summary

A company is looking for a Denials Specialist.

Key Responsibilities

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

Required Qualifications, Training, and Education

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