Denial Prevention Specialist

Remote (must be located in DFW) 6-month contract + extension $18-$20/hr This is primarily a remote position, however there are times the employee might have to come into the office for training, team building events oras requested by their supervisor or manager. JOB SUMMARY The successful candidate will review, research, and 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 This is a work from home (WFH) opportunity. The successful applicant must live within the Greater DFW area and be available to come to the office for equipment pickup, office meetings, and training. Additional details regarding WFH will be discussed as part of the interview process. ESSENTIAL FUNCTIONS Job Duties • 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. QUALIFICATIONS 2 years experience in medical claims recovery and/or collections required Knowledge, Skills and Abilities • 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 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 knowledge of CMS 1500, ICD-9, and CPT coding is preferred. • 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. • Work requires understanding of the requirements of Medicaid, Medicare and insurance billing. Everforth Apex is a world-class IT services company that serves thousands of clients across the globe. When you join Everforth Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRateds Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico. Everforth Apex uses a virtual recruiter as part of the application process. Click here for more details. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Everforth Apex and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. 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