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Why You'll Love This Job

We are looking to hire a highly efficient denials and appeals specialistThe denials and appeals specialists are responsible for timely and accurate resolution of insurance claim denials. The denials and appeals specialist will use payor guidelines, carrier websites and coding edits tools to determine the appropriate steps needed to resolve the denial and submit appeals. To be successful as a denials and appeals specialist, you must be detailed oriented, provide clear and concise documentation. You should have an excellent understanding and utilization of payer contracts and provider manuals. You should be able to calculate the expected claim reimbursement. 

Major Responsibilities: 

  • Research denials and determine if there is a legitimate case for overturning the denial. 
  • Draft and submit appeals. 
  • Inform manager of payor trends or problems or changes in payor requirements. 
  • Follow up on all appeals submitted. 
  • Make clear, detailed notations in EMR system on all accounts worked.  
  • Calculate expected claim reimbursement. 
  • Have a working knowledge of payor policy guidelines and payor contracts.  
  • Have a clear understanding of fee schedules.  

 

  • High School Diploma.  
  • 2 years’ experience preferred.  
  • Excellent verbal and written communication skills.  
  • Excellent organizational skills and attention to detail.  
  • Maintains professional friendly attitude.  
  • Excellent knowledge of payor policies and guidelines.  
  • Familiarity with coding guidelines
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