Denial prevention specialist

About the Role We are seeking a dedicated and detail-oriented Medical Claims & Appeals Specialist to review, research, and resolve claim denials and appeals for various insurance companies. In this role, you will identify payment trends, maximize collections, and ensure accurate reimbursement. Key Responsibilities Claims & Denials Management: Analyze payer denials by denial groupers, review Explanations of Benefits (EOBs) to determine how claims were managed, and prepare/submit targeted appeals for denied services. Follow-Up & Resolution: Contact insurance carriers to verify coverage and check the status of claims and appeals. Reach out to patients and/or third-party payers to resolve outstanding insurance balances and underpaid claims. Account Adjustments: Make necessary financial adjustments as required by specific plan reimbursement guidelines. Cross-Functional Collaboration: Function as a professional liaison between clinical departments and the management team. Additional Duties: Complete special projects and perform other duties as assigned by leadership. Required Qualifications Education: High School Diploma or equivalent. Experience: Minimum of 2 years of recent experience in medical claims recovery and/or collections. Demonstrated experience in Physician Billing with hands-on experience actively processing and submitting appeals. Language: Must be able to fluently read, write, and speak English. Location: Must reside in the Greater DFW area (open to remote candidates within this specific Texas region). Technical Knowledge: Familiarity with CMS 1500, ICD, and CPT coding is highly preferred.


salary: $23.63 - $23.64 per hour
shift: First
work hours: 6 AM - 4 PM
education: High School

Responsibilities

Claims & Denials Management: Analyze payer denials by denial groupers, review Explanations of Benefits (EOBs) to determine how claims were managed, and prepare/submit targeted appeals for denied services.
Follow-Up & Resolution: Contact insurance carriers to verify coverage and check the status of claims and appeals. Reach out to patients and/or third-party payers to resolve outstanding insurance balances and underpaid claims.
Account Adjustments: Make necessary financial adjustments as required by specific plan reimbursement guidelines.
Cross-Functional Collaboration: Function as a professional liaison between clinical departments and the management team.
Additional Duties: Complete special projects and perform other duties as assigned by leadership.

Skills

• Managed Care
• medical claims
• Medical Billing

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on click.appcast.io.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

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