Denial Resolution Specialist

The Rawlings Group • La Grange, KY

384d • Remote

About The Position

The Direct Carrier Denial Resolution Specialist plays a crucial role in the Carrier-to-Carrier team, focusing on resolving payment issues with various insurance companies. This position requires effective communication skills to understand denial codes and formulate appropriate responses. The specialist will also handle administrative tasks related to claims follow-up and documentation, ensuring a smooth resolution process.

Requirements

• Bachelor's degree preferred or equivalent combination of education and experience in health insurance or related fields.
• At least two years of experience as a Denial Resolution Specialist or Recovery Specialist.
• Experience communicating with insurance companies.
• Good oral and written communication skills, including excellent phone communication skills.
• Strong organizational and administrative skills.
• Ability to work well in a team environment.
• Ability to multi-task and work independently as required.
• Excellent time management and analytical skills.

Nice To Haves

• Experience in a professional office environment.
• Familiarity with medical insurance appeals processes.

Responsibilities

• Phone contact with insurance carriers for the resolution and explanation of insurance denials.
• Comprehensive understanding of insurance Explanation of Benefits (EOBs).
• Reviewing claims and reporting denial trends.
• Keeping detailed records of communications with insurance companies.
• Coordinating with providers to inquire about medical records and documentation needed for claim processing.
• Knowledge of filing and tracking medical insurance appeals.
• Maintaining and adhering to the responsibility for client access to retrieve claim forms needed by billing specialists.
• Maintaining and recording all communication with insurance companies and keeping a follow-up schedule.

Benefits

• Disability insurance
• Health insurance
• Dental insurance
• Paid time off
• 401(k) matching
• Flexible schedule
• On-site gym

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED