Denials Specialist I

DCH Health System•Clinics in Millport Fayette Tuscaloosa, AL

23h•Hybrid

About The Position

The Denials and Insurance Follow-Up Specialist manages denied claims, follows up with insurance payers, and supports accurate reimbursement for hospital services. The role contributes to revenue recovery by investigating, correcting, appealing, and resubmitting denied claims, and works with the Revenue Cycle Management (RCM) team to identify denial patterns and improve processes. The position also supports reducing accounts receivable days and improving cash flow. This role includes reviewing denials and preparing appeal documentation, following up on unpaid claims, verifying insurance eligibility and benefits, and communicating with payers to resolve outstanding issues. It also reconciles accounts, addresses payment discrepancies and balances, and generates reports on denial activity and recovery outcomes. The position requires onsite physical presence, with the possibility of a hybrid schedule. It requires a valid driver’s license, automobile liability insurance, personal transportation for office courier services, and some light driving. The work involves prolonged sitting and medium physical demands.

Requirements

High school diploma or GED, or three years of experience in a healthcare setting.
At least six months of clerical experience.
Knowledge of healthcare claims processing, insurance reimbursement, and medical terminology.
Familiarity with payer requirements, denial codes, and appeals processes for Medicare, Medicaid, and commercial insurance plans.
Proficiency with electronic health record (EHR) and revenue cycle management (RCM) software.
Strong analytical skills, including the ability to identify root causes of denials and recommend corrective actions.
Detail-oriented organizational and time-management skills to ensure timely follow-up and adherence to deadlines.
Strong verbal and written communication and interpersonal skills for coordinating with team members, external partners, clients, and staff.
Ability to analyze problems and develop effective solutions.
Ability to read and comprehend instructions, short correspondence, and memos, and to present information effectively in one-on-one and small-group meetings.
Multitasking, prioritization, time-management, and critical-thinking skills.
Proficient computer skills, including Microsoft Office Suites.
Ability to use personal transportation to provide office courier services.
Valid driver’s license and automobile liability insurance.
Very good interpersonal communication and customer service skills.
Normal or corrected hearing and vision within normal range.
Ability to perform the duties with or without reasonable accommodation.
Ability to exert 20–50 pounds occasionally, 10–25 pounds frequently, and up to 10 pounds constantly; good manual and finger dexterity; ability to tolerate prolonged sitting; and ability to perform some light driving.
Ability to work with others, deal with external customers or clients (including occasionally unpleasant people), coordinate letters or memos, and work constantly or consistently with work groups or as part of a team.

Nice To Haves

Prior experience with physician/provider professional fee billing.

Responsibilities

Review and analyze denied claims to determine causes, coordinating with coding, billing, and clinical staff to obtain information or correct errors.
Prepare and submit appeals for denied claims and follow up with payers to ensure timely resolution within filing limits.
Track, document, and report denial reasons, resolution actions, and outcomes; identify trends that may require training or process improvements.
Follow up on unpaid claims with insurance companies and resolve or escalate accounts within hospital timeframes.
Verify insurance eligibility and benefits as needed to validate coverage and support claim correction or resubmission.
Communicate with insurance representatives to resolve outstanding issues, confirm payment status, and clarify payment or coverage discrepancies.
Reconcile accounts, compare payments with expected reimbursement, and address underpayments, overpayments, or unapplied funds.
Work with the RCM team to adjust accounts, accurately apply payments, and resolve patient account balances following denial or underpayment resolution.
Generate and analyze reports on denial rates, follow-up activities, and recovery outcomes.
Collaborate with management on best practices for denial prevention, appeal success, and insurance follow-up efficiency.
Maintain performance, patient and employee satisfaction, and financial standards; comply with employee handbook requirements and DCH policies and procedures.
Follow DCH Behavioral Standards and perform essential functions in a manner that promotes the safety of patients, visitors, and employees.
Identify unsafe practices and take appropriate action to reduce risks and hazards.
Use electronic mail, time and attendance software, learning management software, and the intranet.
Perform other duties as assigned.