Medical Claims Denial Specialist

The Claims Denial Specialist is responsible for accurately processing insurance explanation of benefits (EOB’s), investigating denials, communicating with the insurance companies, office sites, and customer service department regarding claims, re-bill claims and works aging and ERA reports in a timely manner.

Hours: Monday-Friday, 8am-5pm

Fully on-site

ESSENTIAL DUTIES

• Investigate claims denials; refund request and/or other billing issues
• Re-bills/reprocesses claims correctly
• Research coding issues using appropriate resources (Supercoder, NCCI, CPT, payer websites, etc.)
• Quarterly review assigned payer insurance updates
• Utilization of the practice management system and electronic medical record (includes but not limited patient notes, claim data, tasks)
• Communicate with Coordinators regarding billing errors or denials
• Read and/or acknowledge email correspondence daily
• Acknowledge or work tasks daily

EDUCATION

• High School Diploma or Equivalent
• Completion of a Medical Coding and Billing Program (preferred)

CERTIFICATION/LICENSURE REQUIREMENTS

• Medical Coding Certification optional (CPC-A or CPC)

SKILLS AND ABILITIES

• Basic knowledge and understanding of patient confidentiality
• Knowledge of medical terminology
• Strong computer skills
• Knowledge of billing terminology (ICD and CPT codes)
• Ability to type using appropriate grammar and spelling
• Excellent phone etiquette and verbal communication
• Ability to work independently on assigned tasks as well as take direction from coordinator/manager
• Strong organizational and time management skills

Equal Opportunity Employer

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