Denial Prevention Specialist, Revenue Cycle

Integrated Pain Management Medical Group, Inc.•Walnut Creek, CA

13d•$28 - $32•Remote

About The Position

The Denial Prevention Specialist is responsible for proactively identifying, analyzing, and preventing claim denials across all payer categories, with a primary focus on Workers’ Compensation (WC), functional rehabilitation programs (FRP), and pain management services. This role works collaboratively with Patient Access, Coding, Charge Capture, Authorization, Billing, and Clinical teams to ensure claims are submitted accurately and timely, reducing denial rates, improving clean claim performance, and accelerating cash flow. The specialist monitors denial trends, conducts root-cause analysis, develops preventive workflows, and provides ongoing training and feedback to operational teams to ensure compliance with state & federal regulations, OMFS guidelines, and payer-specific requirements. This is a remote role. We are only hiring in the following states: AZ, CA, NM, NV, OR, TX and WA.

Requirements

High school diploma required; associate or bachelor’s degree preferred
Minimum 3-5 years of healthcare RCM experience, preferably in pain management, rehabilitation, or Workers’ Compensation billing
Strong experience with denial management, front-end revenue cycle processes, and payer guidelines
Knowledge of CPT/HCPCS coding, modifiers, and medical billing practices
Understanding of California Workers’ Compensation regulations and OMFS guidelines
Strong analytical and root-cause analysis skills
Experience with multiple EHR/ Practice Management systems (IMS, Nextgen, Athena, eClinicalWorks or similar)
Advanced proficiency in Microsoft Excel (e.g., formulas, pivot tables) and solid skills in other Microsoft Office applications

Nice To Haves

Experience working with California WC billing strongly preferred

Responsibilities

Perform daily and weekly analysis of claim edits, front-end rejections, and historical denial data to identify denial trends.
Conduct root-cause analysis for denials related to: Authorization/Utilization Review (UR) Coding and modifier accuracy WC billing rules compliance Timely filing requirements Documentation deficiencies Charge capture errors
Develop and implement denial prevention action plans in collaboration with RCM leadership
Partner with rehabilitation program teams to ensure services are properly authorized documents, and billed according to WC guidelines
Monitor WC claims for common denial triggers such as missing reports, incorrect dates of injury, and authorization mismatches.
Provide regular feedback to scheduling and intake teams to prevent front-end errors that lead to denials
Support RCM leadership with KPI reporting and performance improvement initiatives
Prepare monthly denial-prevention reports for RCM leadership
Maintain denial-prevention tracking dashboard: Clean claim rate First-pass resolution rate Top denial categories WC denial trends
Assumes other responsibilities as appropriate to the position and organizational needs