The Rejections and Denials Specialist is responsible for working denied eligibility claims for assigned payers and states. This role involves managing multiple work queues, contacting payers online or by phone, updating accounts, and identifying carrier-related denial trends.
The position also requires a strong understanding of charge corrections, FSC transfers, anesthesia modifiers, procedure codes, and diagnostic codes. Some projects may require manual processing using spreadsheets.
Requirements & Qualifications
Required Qualifications
- High school diploma or equivalent certification
Preferred Qualifications
- 3+ years of experience with eligibility-related knowledge
- Knowledge of Medicare/Medicaid, government plans, HMOs, and PPOs
- At least 1 year of strong customer service experience
- 3+ years of denials management experience
- Strong computer skills, including Microsoft Word and Excel
- Ability to think critically and resolve accounts with minimal supervision
- Strong working knowledge of billing procedures, insurance reimbursement, and guidelines, preferably in a medical or anesthesia setting
- Ability to multitask and work both independently and in a team
- Effective communication skills with patients, insurance companies, co-workers, and management
- Ability to work at a high level of productivity and quality
- Ability to collaborate with team leadership to improve processes
- Strong organization and time management skills
- Ability to maintain confidentiality and HIPAA compliance
Benefits & Perks
Benefits Package
- Paid time off
- Health, life, vision, dental, disability, and AD&D insurance
- Flexible spending accounts / health savings accounts
- 401(k)
- Leadership and professional development opportunities
Location
Florida, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
4 weeks ago