Denial prevention specialist

Job Summary As a Medical Claims Appeals Specialist, you will research, resolve, and prepare appeals for claim denials across various payors including Medicare, Medicaid, Commercial, and Managed Care. You will analyze payment trends to maximize collections in a fast-paced environment. Responsibilities Review Explanation of Benefits (EOB) and analyze payer denials by denial groupers to submit successful appeals. Contact insurance carriers and patients to resolve outstanding balances, underpaid claims, and verify insurance. Make necessary account adjustments as required by plan reimbursement guidelines. Act as a reliable liaison between clinical departments and the management team. Qualifications & Skills Must reside in the Greater DFW, TX area (open to remote TX candidates able to commute to DFW as requested). 2+ years of recent experience in medical claims recovery, physician billing, and/or collections. Hands-on, proven experience actively preparing and submitting medical appeals Must be able to read, write, and speak English fluently High School Diploma required (Associate's Degree preferred). Familiarity with CMS 1500, ICD-9, CPT coding, and insurance regulations preferred. Excellent communication, customer service, and accurate alpha/numeric data entry skills

salary: $23.63 - $23.64 per hour
shift: First
work hours: 7:30 AM - 4 PM
education: High School

Responsibilities

Review Explanation of Benefits (EOB) and analyze payer denials by denial groupers to submit successful appeals.
Contact insurance carriers and patients to resolve outstanding balances, underpaid claims, and verify insurance.
Make necessary account adjustments as required by plan reimbursement guidelines.
Act as a reliable liaison between clinical departments and the management team.

Skills

• Explanation of Benefits
• account adjustments
• analyze payer denials

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.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.