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 and submit appeals based on dispute reasons and payer guidelines
• Research contract terms and compile supporting documentation for appeals and payment variance trends

Required Qualifications

• High School Diploma or equivalent, with some college coursework preferred
• 3 - 5 years of experience in a hospital business environment performing billing and/or collections
• Intermediate understanding of Explanation of Benefits forms, Managed Care Contracts, and hospital billing requirements
• Intermediate knowledge of ICD-9, HCPCS/CPT coding, and medical terminology
• Intermediate Microsoft Office skills