Denials Management Specialist - Remote

Overview

The Denials Management Specialist plays a critical role in ensuring accurate and timely resolution of denied claims, identifying trends, and implementing effective appeals strategies to maximize revenue recovery.

In Short

• Analyze and manage claim denials to identify trends, root causes, and potential resolutions.
• Conduct thorough investigations of denied claims, including coding reviews and payer-specific policy research.
• Communicate with payers to appeal denied claims and ensure timely resolution.
• Manage the complete claims resolution process, including appeals and follow-up, to ensure proper reimbursement.
• Collaborate with billing staff, coding professionals, and clinical teams to provide feedback and implement denial prevention strategies.
• Maintain accurate documentation of denial management activities, including tracking outcomes and process improvements.
• Stay updated on payer policies, medical coding guidelines, and regulatory changes affecting claims processing.
• Provide regular reports and analysis of denial patterns to management, offering actionable recommendations.

Requirements

• Strong knowledge of claims adjudication, appeals, and reimbursement processes.
• Ability to identify denial trends, root causes, and develop strategic solutions.
• Strong written and verbal communication skills for payer interactions and internal collaboration.
• Proven ability to work cross-functionally with billing, coding, and clinical teams to optimize revenue cycle performance.
• Ability to retain and apply complex information accurately and efficiently.
• Experience using claims management and billing software to track and resolve denials.
• Minimum of 5 years of experience in medical claims denials management, including resolution and appeals processes.
• Familiarity with CPT, ICD-10, and HCPCS coding; certification (CPC, CCS-P) is a plus.
• Experience in eye care specialties (ophthalmology, optometry, retina, cataracts) and ASC operations is highly desirable.
• Strong organizational skills with the ability to prioritize and manage multiple tasks efficiently.

Benefits

• PTO Accruals Start at 3 Weeks
• Comprehensive Medical and Dental Insurance
• Company-Paid Optical Allowance
• Company-Paid Routine Eye Care
• Short-Term and Long-Term Disability Insurances
• Educational Allowance
• Paid Holiday Program
• 401K with Company Match