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Claims Denial Analyst
A company is looking for a Claims Denial Analyst- Remote. Key Responsibilities Validate denial reasons and ensure accurate coding in DCM, coordinating with the Clinical Resource Center as needed Generate appeals based on dispute reasons and payer guidelines, and escalate exhausted appeal efforts for resolution Research contract terms and compile documentation for appeals, while escalating denial or payment variance trends to leadership Required Qualifications High School Diploma or equivalent; some college coursework preferred 3 - 5 years of experience in a hospital business environment performing billing and/or collections Intermediate understanding of Explanation of Benefits forms, Managed Care Contracts, and hospital billing form requirements Intermediate knowledge of ICD-9, HCPCS/CPT coding, and medical terminology Intermediate Microsoft Office skills
A company is looking for a Claims Denial Analyst- Remote.
Key Responsibilities
Validate denial reasons and ensure accurate coding in DCM, coordinating with the Clinical Resource Center as needed
Generate appeals based on dispute reasons and payer guidelines, and escalate exhausted appeal efforts for resolution
Research contract terms and compile documentation for appeals, while escalating denial or payment variance trends to leadership
Required Qualifications
High School Diploma or equivalent; some college coursework preferred
3 - 5 years of experience in a hospital business environment performing billing and/or collections
Intermediate understanding of Explanation of Benefits forms, Managed Care Contracts, and hospital billing form requirements
Intermediate knowledge of ICD-9, HCPCS/CPT coding, and medical terminology
Intermediate Microsoft Office skills