Denials Follow Up - Provider Enrollment Team

Salary:
See details in Job Description

Our client is seeking a Denials Follow-Up Specialist – Provider Enrollment. This role involves investigating, resolving, and preventing insurance claim denials related to provider enrollment, credentialing, and payer participation status. The specialist will support revenue cycle operations by identifying enrollment-related claim issues, coordinating with internal teams, and working with insurance payers to resolve outstanding claims and secure appropriate reimbursement. The ideal candidate will possess a strong understanding of healthcare claims processing, insurance payer requirements, provider enrollment workflows, and denial management, and will be detail-oriented, analytical, and capable of managing a high-volume workload while meeting productivity, quality, and financial performance goals.

• Review and analyze denied, rejected, and unpaid healthcare claims related to provider enrollment, credentialing, payer registration, and network participation issues.
• Investigate denial reasons, including providers not enrolled or credentialed with the payer, enrollment effective-date discrepancies, missing or incomplete provider records, incorrect provider identifiers, and billing provider or rendering provider enrollment mismatches.
• Perform timely claim follow-up with commercial insurance payers, Medicare, Medicaid, and other applicable reimbursement entities to determine the cause of denials and identify resolution requirements.
• Verify provider enrollment status, effective dates, payer participation, National Provider Identifier (NPI), and other relevant provider information to support accurate claim adjudication.
• Collaborate with provider enrollment, credentialing, billing, coding, contracting, and other revenue cycle teams to resolve enrollment-related barriers to reimbursement.
• Identify claims requiring enrollment updates, retroactive effective-date corrections, payer record modifications, or additional documentation.
• Submit corrected claims, reconsiderations, appeals, and supporting documentation as appropriate and within payer-specific filing and appeal deadlines.
• Maintain accurate and detailed documentation of denial findings, payer communications, claim actions, resolution plans, and follow-up activities in designated systems.
• Monitor assigned accounts and outstanding claims to ensure timely follow-up, appropriate escalation, and resolution in accordance with established workflows.
• Identify recurring denial trends, payer processing issues, and systemic enrollment gaps that may contribute to delayed or lost reimbursement.
• Escalate unresolved enrollment issues, aging claims, timely filing risks, and high-dollar accounts to the appropriate internal teams or leadership.
• Support denial prevention initiatives by communicating recurring issues and recommending process improvements to reduce avoidable denials and rework.
• Meet established productivity, quality, turnaround time, and financial recovery expectations while maintaining compliance with applicable policies and regulations.

• 3+ years in AR experience.
• Experience with Medicaid HMO.
• Experience with Emergency Medicine and/or hospitalist medicine specialties.
• Experience with working claims that are denied based on provider enrollment criteria (taxonomy codes incorrect, NPI, timely filing, carrier IDs, provider effective dates etc).

• Schedule:
  
  Monday
  - Thursday onsite, Fridays remote.
• Flexible start time between 6am-8:30am, with end time no later than 5pm (40 hour work week).
• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits /…