Senior Denials & Appeals Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Supervise and manage the appeals process for denied claims, ensuring the timely and precise submission in accordance with payer guidelines.

• Address complex or high-value denials and consult with relevant staff to resolve outstanding issues.

• Examine denied claims to uncover root causes, trends, and patterns.

• Collaborate with various departments to implement corrective actions and prevent future occurrences.

• Engage with billing, coding, payer relations, and clinical teams to tackle denial-related challenges.

• Offer guidance on coding, documentation, and billing practices.

• Ensure that denials and appeals adhere to applicable regulations and guidelines, including HIPAA.

• Maintain comprehensive and accurate documentation.

• Prepare and submit detailed appeal letters alongside supporting documents to payers.

• Provide training and support to junior specialists in denials and appeals.

• Monitor key performance indicators (KPIs) such as appeal success rates, denial trends, and resolution times.

• Report findings to senior management.

⛳️ Requirements

• A college degree is preferred, or equivalent experience of 5 or more years.

• At least 5 years of experience in medical billing.

• Strong preference for candidates with molecular laboratory billing experience.

• Medical billing experience may be accepted in lieu of a bachelor’s degree.

• Knowledge of patient protections under HIPAA and appropriate management of protected health information (PHI).

• Familiarity with health insurance and related terminology.

• Excellent communication and interpersonal skills.

• Detail-oriented with strong analytical and problem-solving skills.

• Comprehensive understanding of insurance guidelines, CPT/ICD-10 codes, and medical terminology.

• Exceptional attention to detail and effective time management skills.

• Strong communication and problem-solving capabilities.

• Proficient in Microsoft Office Suite and healthcare software tools.

🏝️ Benefits

• Equal opportunity employer dedicated to fostering an inclusive and diverse workforce.

• Full-time remote work arrangement.