Overview:
We are seeking an experienced and detail-oriented **Denial Management Specialist** to join our team. This key role is responsible for ensuring accurate coding, resolving denied claims, and maintaining efficient revenue cycle operations. The ideal candidate will have a solid understanding of medical coding, billing, and denial management, handling all aspects of the billing process to ensure timely and accurate reimbursements. If you thrive in a fast-paced environment and have a strong attention to detail, we encourage you to apply.
Key Responsibilities:
- Denial Management & Resolution:
- Analyze denied claims to identify the root cause (e.g., coding errors or missing information).
- Work closely with insurance payers and internal teams to resolve denials and resubmit claims.
- Conduct research and investigations to address systemic denial issues.
- Prepare and submit appeals for denied claims, ensuring compliance with payer deadlines.
- Payer Communication & Appeals:
- Communicate with insurance companies to resolve denial reasons and secure required documentation for claims.
- Establish strong relationships with payers for efficient denial resolution.
- Follow up proactively to resolve outstanding claims and prevent future denials.
- Patient Demographic & Insurance Verification:
- Enter and update patient demographic and insurance information in the system.
- Verify insurance coverage, benefits, referrals, and authorizations, ensuring they are correctly attached to claims.
- Communicate with clinical staff to clarify any discrepancies.
- Medical Coding & Charge Review:
- Assign appropriate CPT, HCPCS, and ICD-10 codes based on clinical documentation.
- Review and correct charges to ensure accurate coding of services provided.
- Maintain up-to-date knowledge of coding standards and payer requirements.
- Claim Submission & Front-End Rejection Resolution:
- Prepare, review, and submit clean claims for services to insurance companies.
- Resolve front-end claim rejections by correcting errors related to demographics, coding, and insurance.
- Resubmit corrected claims and track their resolution to reduce accounts receivable days.
- Compliance & Quality Assurance:
- Ensure billing and denial management practices comply with healthcare regulations and payer policies.
- Conduct audits on denied claims and appeals for accuracy and compliance.
- Stay updated on changes in payer requirements and industry regulations.
- Technology & System Use:
- Use medical billing software, EHR, and denial management systems to track and resolve denied claims.
- Troubleshoot system issues related to claim submissions and denial tracking.
- Stay current on best practices and advancements in denial management technology.
Education, Qualifications and Skills:
- High School Diploma, GED, or suitable equivalent. Associate or bachelor’s degree preferred.
- Minimum of two (2) years of experience in medical billing. Minimum of five (5) years of medical billing work experience, with at least two (2) years in denial management preferred.
- Knowledge of revenue cycle processes and healthcare insurance regulations.
- Excellent communication skills, both verbal and written.
- Strong customer service and negotiation skills.
- Proficient in Microsoft Office applications and billing systems.
- High attention to detail and ability to manage multiple tasks/projects under deadlines.
Job Type: Full-time
Pay: $24.00 - $28.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Retirement plan
Ability to Commute:
- Round Rock, TX 78681 (Required)
Ability to Relocate:
- Round Rock, TX 78681: Relocate before starting work (Required)
Work Location: Hybrid remote in Round Rock, TX 78681
