Denials Management Specialist

Southwoods Health•Boardman, OH

About The Position

Southwoods Health is hiring a Denials Management Specialist to correspond with insurance carriers about aged, unpaid claims. The role focuses on securing and expediting payments through proactive follow-up and strategic appeals resolution. The specialist manages denial worklists and credit balances, contacts payers, prepares appeals, documents interactions, resolves claim issues, and helps maintain regulatory compliance.

Requirements

Completed training or courses in business office operations, computer applications, and medical terminology.
Comprehensive knowledge of revenue-cycle operations and proven measures for resolving complex claim issues.
Effective communication skills.
Professional problem-solving capabilities.
Ability to maintain a professional demeanor and strong ethical principles.

Nice To Haves

Collection or billing certification is highly preferred.

Responsibilities

Review tasks, credit balances, and denial worklists daily and weekly.
Contact insurance companies to determine the status of unpaid or denied accounts and navigate insurance websites.
Prepare, file, and submit formal insurance appeals.
Send copies or supporting clinical documentation required by insurance carriers.
Record detailed notes about interactions with insurance companies and patients in patient account records.
Mail insurance claim forms with required attachments.
Investigate insurance credit balances and work toward resolution.
Identify and report billing errors to the supervisor for policy corrections.
Review insurance newsletters and websites for policy updates.
Ensure processes comply with regulatory agencies, including OSHA, ODH, BOP, and TJC.