Denials Specialist III

Job description

Overview The Denials and Insurance Follow-Up Specialist is responsible for managing denied claims, following up with insurance payers, and ensuring accurate reimbursement for hospital services. This role is critical to optimizing revenue recovery by investigating, correcting, and resubmitting denied claims while working closely with the Revenue Cycle Management (RCM) team to identify and address patterns in denials. The ideal candidate will have strong analytical skills and experience in medical billing and insurance follow-up, with a focus on reducing accounts receivable days and improving cash flow. Responsibilities: Denial Management: - Review and analyze denied claims to determine the cause of denial, coordinating with coding, billing, and clinical staff as needed to gather additional information or correct claim errors. - Prepare and submit appeal documentation for denied claims, following up with payers to ensure resolution within timely filing limits. - Track, document, and report denial reasons, resolution actions, and outcomes, identifying patterns and trends that require additional training or process improvements. Insurance Follow-Up: - Conduct timely follow-up on unpaid...