Denial Prevention Specialist

Software Guidance & Assistance, Inc., (SGA), is searching for a Denial Prevention Specialist for a Contract assignment with one of our premier Healthcare clients in Weatherford, TX .

This is a work from home (WFH) opportunity. The successful applicant must live within the Greater DFW area and be available to come to the office for equipment pickup, office meetings, and training. Additional details regarding WFH will be discussed as part of the interview process.

The successful candidate will review, research, and resolve claim denials and appeals for various insurance companies while identifying payment trends in an effort to maximize collections. A successful candidate should have, but not be limited to the following skills:

• Capable of reviewing Explanation of Benefits (EOB) from payors to determine how the claims were managed.
• Contacting insurance carriers to check on the status of claims, appeals, and insurance verification.
• Knowledgeable with payors including Managed Care, Commercial, Medicare, and Medicaid.
• Preparing/Submitting appeals related to denied services.
• Analyze payer denials by denial groupers and submit appeals.
• Contact patients and/or third party payers to resolve outstanding insurance balances and underpaid claims.
• Make necessary adjustments as required by plan reimbursement.
• Functions as a liaison between clinical departments and MSRDP management team.
• Completes special projects as assigned.
• Performs other duties as assigned.

• High School Diploma or Associate’s Degree
• 2 years experience in medical claims recovery and/or collections required
• Work requires a self-starter, with ability to work well as part of a team and independently.
• Work requires ability to communicate effectively with patients, insurance companies, clinical staff and management.
• Work requires ability to handle large volumes of work.
• Work requires