Pain Management Claims Resolution Specialist

3 weeks ago


Austin, Texas, United States Pain Specialists of America LLC Full time
Job Summary

Pain Specialists of America LLC is seeking an experienced Denials Management Coordinator to oversee the resolution of denied claims and ensure timely reimbursement from insurance carriers.

Key Responsibilities
  • Denial Analysis and Resolution: Review and analyze insurance denials, underpayments, and appeals for pain management services and ASC claims.
  • Auditing and Corrective Action: Investigate root causes of denials and develop strategies to address them.
Appeals and Follow-Up
  • Claims Processing: Prepare and submit detailed and timely appeals to insurance payers for denied or underpaid claims.
  • Resolution Tracking: Maintain follow-up on outstanding appeals and claims to ensure resolution.
Trend Identification and Reporting
  • Performance Metrics: Track and monitor denial trends to identify areas for improvement.
  • Reporting Requirements: Provide regular reports to leadership on denial patterns, resolution rates, and financial impact.
Collaboration and Training
  • Interdepartmental Coordination: Work closely with billing, coding, and clinical teams to address documentation and coding issues that lead to denials.
Compliance and Guidelines
  • Regulatory Awareness: Stay current with industry standards, payer policies, and regulatory changes impacting billing and claims processing.
  • Compliance Protocols: Ensure all activities comply with HIPAA and other relevant regulations.
System Optimization
  • Billing System Utilization: Utilize billing software and electronic medical records (EMR) systems to streamline denial management processes.
  • Process Enhancement: Recommend system and workflow improvements to enhance claim accuracy and efficiency.
Estimated Salary Range: $65,000 - $80,000 per year

This position requires a minimum of 3 years of experience in medical/facility denials management, or revenue cycle operations. The ideal candidate will have experience in pain management and ambulatory surgery center (ASC) billing, including a strong understanding of coding, payer guidelines, and appeals processes.

The successful candidate will possess proficiency in medical coding (CPT, ICD-10, and HCPCS) and knowledge of modifiers specific to pain management and surgical procedures. They will be proficient in utilizing billing software and EMR systems to streamline denial management processes and recommend system and workflow improvements to enhance claim accuracy and efficiency.



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