Denial Prevention Specialist

This is primarily a remote position, however there are times the employee might have to come into the office for training, team building events or as requested by their supervisor or manager

• The successful candidate will review, research, resolve claim denials and appeals for various insurance companies while identifying payment trends in an effort to maximize collections. A successful candidate should have, but not be limited to the following skills:
• Capable of reviewing Explanation of Benefits (EOB) from payors to determine how the claims were managed.
• Contacting insurance carriers to check on the status of claims, appeals, and insurance verification.
• Knowledgeable with payors including Managed Care, Commercial, Medicare, and Medicaid
• Preparing/Submitting appeals related to denied services
• Analyze payer denials by denial groupers and submit appeals.
• Contact patients and/or third party payers to resolve outstanding insurance balances and underpaid claims.
• Make necessary adjustments as required by plan reimbursement.
• Functions as a liaison between clinical departments and MSRDP management team.
• Completes special projects as assigned.
• Performs other duties as assigned.

• 2 years experience in medical claims recovery and/or collections required
• Work requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment.
• Work requires good organizational, flexibility and analytical skills when resolving more complex unpaid claims.
• Work requires knowledge of billing and/or collections and regulations.
• Work requires understanding of the requirements of Medicaid, Medicare and insurance billing.
• Work requires a self-starter, with ability to work well as part of a team and independently.
• Work requires ability to communicate effectively with patients, insurance companies, clinical staff and management.
• Work requires ability to handle large volumes of work.
• Work requires ability to work in a fast paced, production oriented environment.
• Work requires excellent customer service skills.
• Work requires one to exhibit excellent work ethics and commitment to job responsibilities.
• Work requires one to possess a professional and courteous demeanor while being assertive and confident in their collection efforts.
• Work requires one to possess quick and accurate alpha/numeric data entry skills.
• Work requires presence of a positive image that reflects well on the organization.
• Work requires strong written and verbal communication skills.

• Associate's Degree
• Work requires knowledge of CMS 1500, ICD-9, and CPT coding is preferred.

• 2 years experience in medical claims recovery and/or collections required
• Work requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment.
• Work requires good organizational, flexibility and analytical skills when resolving more complex unpaid claims.
• Work requires knowledge of billing and/or collections and regulations.
• Work requires understanding of the requirements of Medicaid, Medicare and insurance billing.
• Work requires a self-starter, with ability to work well as part of a team and independently.
• Work requires ability to communicate effectively with patients, insurance companies, clinical staff and management.
• Work requires ability to handle large volumes of work.
• Work requires ability to work in a fast paced, production oriented environment.
• Work requires excellent customer service skills.
• Work requires one to exhibit excellent work ethics and commitment to job responsibilities.
• Work requires one to possess a professional and courteous demeanor while being assertive and confident in their collection efforts.
• Work requires one to possess quick and accurate alpha/numeric data entry skills.
• Work requires presence of a positive image that reflects well on the organization.
• Work requires strong written and verbal communication skills.