Clinical Denial Specialist
About The Position
Claims & Documentation Follow up on pending authorizations and denied claims; assist in appeals when necessary. Frequently visit payor portals for updates on cases Document status of claims within the EMR system. Communication Respond to patient inquiries regarding billing and insurance processes in a professional manner. Coordination & Compliance Collaborate with clinical staff, case managers, and revenue cycle teams to ensure timely updates and accurate records. Maintain compliance with HIPAA and hospital policies, safeguard patient information. Administrative Support Update and maintain data in electronic health records (EHR) and billing systems. Generate reports on claim status, authorizations, and reimbursement trends for management review.
Requirements
- High school diploma or equivalent; medical assistant certification preferred.
- Minimum 3+ years of experience in healthcare administration, insurance verification, or medical billing.
- Knowledge of medical terminology, CPT/ICD coding, and payer authorization processes.
- Proficiency in EHR systems and insurance portals.
- Strong organizational, communication, and problem-solving skills.
Nice To Haves
- Medical Assistant Certification
- Excel/PowerPoint Skills
Responsibilities
- Claims & Documentation Follow up on pending authorizations and denied claims; assist in appeals when necessary.
- Frequently visit payor portals for updates on cases
- Document status of claims within the EMR system.
- Communication Respond to patient inquiries regarding billing and insurance processes in a professional manner.
- Coordination & Compliance Collaborate with clinical staff, case managers, and revenue cycle teams to ensure timely updates and accurate records.
- Maintain compliance with HIPAA and hospital policies, safeguard patient information.
- Administrative Support Update and maintain data in electronic health records (EHR) and billing systems.
- Generate reports on claim status, authorizations, and reimbursement trends for management review.
Benefits
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
