Insurance Denial Specialist
$52,000–$66,560 year
On-site · Madera, California, United States
Job Summary
The Insurance Denial Specialist role focuses on reviewing, analyzing, and resolving denied or underpaid insurance claims to ensure timely reimbursement for hospital and professional services. Responsibilities include investigating denial reasons, preparing and submitting timely appeals with supporting documentation, coordinating with coding, billing, case management, utilization review, and clinical departments, monitoring payer portals, identifying denial trends, ensuring compliance with CMS and HIPAA, and contributing to process improvements to reduce denials and improve revenue cycle performance.
Required Qualifications
- High school diploma or equivalent
- Associate degree in Healthcare Administration, Medical Billing & Coding, or related field preferred
- Minimum of two (2) years of healthcare billing, insurance follow-up, denial management, or revenue cycle experience preferred
- Hospital acute care billing experience preferred
- Knowledge of medical terminology, CPT, ICD-10, and HCPCS coding concepts
- Understanding of commercial insurance, Medicare, Medi-Cal, and managed care reimbursement methodologies
- Familiarity with claim appeals and denial resolution processes
- Strong analytical and problem-solving skills
- Ability to prioritize workload and meet deadlines
- Excellent written and verbal communication skills
- Proficient computer skills, including EMR and billing systems
- Ability to work independently and collaboratively in a fast-paced environment
- Preferred Certifications: CPB or related certification
- Experience with hospital information systems and revenue cycle platforms
- Experience with Meditech EHR system preferred
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