Denial Resolution Specialist

• Review denied claims in MEDITECH denial work queues: DEN-ELIG-*, DEN-AUTH-*, DEN-CODING-*, DEN-MEDNEC-*, and DEN-TIMELY-*
• Analyze Explanation of Benefits (EOB), Electronic Remittance Advice (ERA), and payer codes (CARC/RARC)
• Correct and resubmit claims
• Submit reconsiderations and formal appeals
• Request additional documentation
• Work denials within established service-level agreements, typically within 5 days
• Prepare and submit first-level and second-level appeals
• Gather and review medical records, coding documentation, and authorization details
• Track appeal status through resolution
• Escalate complex or high-dollar cases as needed
• Work assigned denial accounts daily
• Meet productivity targets and prevent backlog accumulation
• Prioritize high-dollar claims, timely filing deadlines, and aging denials
• Contact insurance companies to clarify denial reasons, request reconsideration, and verify appeal requirements
• Maintain knowledge of payer-specific policies and updates
• Accurately document actions taken on accounts
• Ensure compliance with CMS guidelines, payer contracts and requirements, and organizational policies
• Maintain regular and predictable attendance
• Perform other essential duties as assigned
• Contribute to denial resolution, revenue recovery, denial prevention, and revenue cycle improvement

• High school diploma or equivalent required
• Bachelor’s degree is preferred
• Residency in Missouri or Kansas is required
• 3+ years of healthcare billing or revenue cycle experience
• Experience working in an EHR system (MEDITECH preferred)
• Experience working in clearinghouse (SSI Preferred)
• Strong understanding of insurance billing and claims lifecycle
• Strong understanding of EOB/ERA interpretation
• Strong understanding of payer rules and denial codes
• Prior experience in denial management or appeals
• Analytical and critical thinking skills
• Strong attention to detail
• Problem-solving and root cause identification
• Effective communication and negotiation skills
• Ability to manage high volumes and deadlines
• Ability to sit and stand intermittently 8 to 10 hours a day
• Ability to use standard office equipment, including the telephone and computer keyboard
• Ability to work under pressure while meeting near-100% accuracy requirements and inflexible deadlines
• Manual/bi-manual dexterity, near vision, speech, and hearing
• Ability to lift or carry up to 40 lbs.
• Ability to occasionally walk on uneven surfaces

Demonstrates expertise in healthcare billing and revenue cycle management, with a strong focus on denial management, appeals processes, and compliance with payer-specific policies. Proficient in analyzing EOBs and ERAs, and skilled in effective communication and problem-solving to resolve claims denials.

• Healthcare Billing Experience
• Denial Management
• EOB/ERA Interpretation
• MEDITECH Proficiency
• Analytical Skills

• Claims Lifecycle Management
• Payer Rules Understanding
• Denial Codes Knowledge
• Revenue Cycle Improvement
• Documentation Accuracy

• Attention to Detail
• Problem-Solving
• Effective Communication
• Negotiation Skills
• Critical Thinking

• CMS Guidelines
• Payer Contracts
• Revenue Recovery
• Denial Prevention
• Service-Level Agreements

• EHR System
• MEDITECH
• Clearinghouse (SSI)