Denial Management Specialist

Job Description

We are seeking a detail oriented and analytical professional to join our team as a Denial Management Specialist within the Medical/Behavioral Health domain. The primary responsibility of this role is to identify, analyze, and resolve claim denials to ensure accurate and timely reimbursement. The ideal candidate will possess a strong understanding of insurance processes, medical billing, and payer guidelines, particularly within behavioral health services. This position requires excellent problem-solving skills, attention to detail, and the ability to multitask effectively while maintaining a high level of accuracy and compliance. The candidate should also demonstrate strong communication abilities to coordinate with payers, clients, and internal teams for swift resolution of denied or underpaid claims.

Key Responsibilities: 

• Review and analyze denied or underpaid medical and behavioral health claims to determine root causes.

• Work with insurance companies to resolve denials and ensure timely and accurate reimbursement.

• Identify recurring denial trends and collaborate with billing and clinical teams to prevent future occurrences.

• Prepare and submit appeals with appropriate supporting documentation in accordance with payer requirements.

• Maintain detailed records of denial activities, appeal statuses, and resolutions in the billing system.

• Communicate effectively with payers, clients, and internal departments to ensure issues are addressed promptly.

• Monitor claim status and follow up proactively to reduce outstanding accounts receivable.

• Ensure compliance with all HIPAA, payer, and organizational policies during all denial management processes.

Requirements: 

• High school diploma or equivalent; associate’s or bachelor’s degree in accounting, finance, or a related field is a plus. 

• Proven experience in billing, accounting, or administrative roles. 

• Strong attention to detail and numerical accuracy. 

• Proficiency in Microsoft Excel and billing/accounting software. 

• Excellent communication and organizational skills. 

• Ability to work independently and meet deadlines. 

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