Claims Denial Specialist - Revenue Cycle - Okmulgee

Minimum Qualifications Education -High school diploma/GED required. Associate's degree preferred. Experience - Five (5) years Revenue Cycle/Billing Office experience and Medicare billing required. Licenses & Certification Knowledge & Skills Proficient in hospital and/or clinic billing and follow up Knowledge of medical terminology Demonstrate strong knowledge in the use of ICD-10-CM, CPT, HCPCS, and Revenue Codes. Experience with payer portals and healthcare billing software. Extensive knowledge of the major insurance companies' billing policies to ensure compliance Strong analytical and problem-solving abilities Basic knowledge of insurance claim forms Working knowledge in specific specialties within the hospital and/or clinic billing areas. Ability to read, comprehend, and follow oral and written instructions Must have the ability to establish and maintain effective working relationships with patients, co-workers and the general public Job Summary The Denials Specialist is responsible for reviewing, analyzing, and resolving denied medical claims to ensure proper reimbursement for healthcare services. The Denials Specialist ensures timely and accurate resubmission or appeal of denied claims to optimize reimbursement and minimize revenue loss. This position works closely with payers, billing staff, and clinical teams to identify root causes of denials and implement solutions to prevent future occurrences. This position is in office/person (not remote). Work Environment Work is performed in a business office environment. Occasional overtime and travel may be required. Physical Demands Required sitting and standing associated with a normal office environment. Manual dexterity is needed for using a calculator and computer keyboard. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, skills and working conditions may change as needs evolve. Essential Functions Review and analysis of benefits (EOBs), electronic remittance advice (ERAs), and payer correspondence related to denied claims. Research denial reasons and take appropriate actions, including correcting claim errors, submitting appeals, or resubmitting claims. Research denial reasons and take appropriate actions, including correcting claim errors, submitting appeals, or resubmitting claims. Communicate with insurance companies, patients, and internal departments to resolve outstanding issues. Maintain accurate documentation of all follow-up activities and appeal efforts in the billing system. Identify trends and recurring denial patterns; assist with root cause analysis and report findings to management. Stay up to date on payer policies, coding guidelines, and reimbursement rules. Collaborate with billing, coding, and compliance teams to improve first-pass claim acceptance rates. Assist in the development and implementation of denial management workflows and best practices. Assist with payor enrollment/credentialing. Keep a positive attitude. Meet departmental productivity and quality benchmarks. Participate in educational activities and attend staff meetings when needed. Regular attendance is required. Maintain a neat, clean and clutter-free work area always. Must be well organized, detail oriented and strive to work efficiently and accurately. Maintain strict confidentiality; adhere to all HIPPA guidelines and regulations. Adhere to the organizations (department) values and contribute to the fulfillment of its mission. Perform other duties as assigned. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Broughton Group