Medical Claims Denial Specialist
$41,600–$41,600 year
On-siteSarasota, Florida, United States
Job Summary
Review and analyze denied insurance claims to determine root causes and identify corrective actions. Prepare and submit appeals with supporting documentation to insurance companies to resolve denials efficiently. Collaborate with healthcare providers, billing teams, and insurance representatives to gather information and clarify discrepancies. Maintain accurate records of denied claims and appeals to track trends and improve denial management processes. Monitor insurance policies and regulatory changes to ensure compliance and update resolution strategies accordingly. Generate reports on denial rates and recovery efforts to inform management and support continuous improvement. Provide training and guidance to staff on best practices for claim submission and denial prevention.
Required Qualifications
- High school diploma or equivalent
- Associate degree or higher in healthcare administration or related field
- Minimum of 2 years experience in medical billing, coding, or claims denial management within the healthcare industry
- Strong knowledge of medical insurance policies, billing procedures, and healthcare reimbursement processes
- Proficiency with electronic health record (EHR) systems and medical billing software
- Excellent communication and organizational skills with attention to detail
Desired Qualifications
- Certification such as Certified Professional Biller (CPB) or Certified Coding Specialist (CCS)
- Experience working with Medicare, Medicaid, and commercial insurance providers
- Familiarity with healthcare regulations including HIPAA and the Affordable Care Act
- Advanced proficiency in data analysis and reporting tools
- Demonstrated ability to lead denial management projects or teams
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