Denials Specialist

This is a Fully Remote Job
1. About Our Client:
The organization operates within the healthcare services sector, focusing on improving financial and clinical performance for healthcare providers across more than 135 regions nationwide. It supports transitions from volume to value-based care, aiming to enhance patient experience and healthcare quality, cost, and access.
2. About the Opportunity:
The Denials Specialist plays a critical role in managing and resolving denied or underpaid healthcare claims. This position is responsible for validating denial reasons, coordinating appeals processes, and escalating payment issues to leadership, directly influencing the organization''s revenue cycle effectiveness.
3. Responsibilities:
Validate denial reasons and ensure accurate coding reflecting these reasons
Coordinate with clinical resources for consultations or referrals as needed
Generate appeals following payor-specific contract terms and guidelines
Submit appeals according to payer requirements, including online reconsiderations
Escalate unresolved appeals for further resolution
Participate in payer-related projects as directed
Research contract terms and compile supporting documentation for appeals and adjudication issues
Determine corrective actions and appropriately code and route accounts
Escalate denial or payment variance trends to leadership for payor escalation
4. Requirements:
Intermediate understanding of Explanation of Benefits, Managed Care Contracts, and relevant federal and state requirements
Intermediate knowledge of hospital billing forms (UB-04)
Intermediate understanding of ICD-9, HCPCS/CPT coding, and medical terminology
Intermediate skills with Microsoft Word and Excel
Advanced business letter writing skills, including correct grammar and punctuation
High School Diploma or equivalent; some college coursework preferred
3 to 5 years of experience in hospital billing and/or collections
5. Pay Range and Compensation Package:
Pay: $18.60 to $28.00 per hour, depending on location, qualifications, and experience
Position may be eligible for a signing bonus for qualified new hires
Time and a half pay for company-observed holidays
6. Benefits & Perks:
Medical, dental, vision, disability, and life insurance
Paid time off, including vacation and sick leave (minimum 12 days per year)
401(k) plan with up to 6% employer match
Ten paid holidays annually
Health savings accounts and flexible spending accounts
Employee assistance and discount programs
Voluntary benefits such as pet, legal, accident, critical illness, long-term care, childcare, and various insurance options
Paid leave in accordance with Colorado’s Healthy Families and Workplaces Act for Colorado employees
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Work arrangement
Yes