Denial Specialist

5 hours ago


Tampa, Florida, United States Accounting Now Full time
Job Title: Denial Specialist

At Accounting Now, we are seeking a highly skilled Denial Specialist to join our team. As a key member of our revenue cycle team, you will play a critical role in ensuring timely and accurate reimbursement for our clients.

Key Responsibilities:
  • Denial Management: Conduct comprehensive reviews of insurance denials and work with Clinical Denials Nurses and Coding Denials Specialists to compile documentation and medical records for appeals or corrected claims.
  • Appeals and Reconsiderations: Gather and submit all required documentation, including medical records, to support medical necessity for reconsideration, appeal, or retro authorization to insurance carriers.
  • Communication and Collaboration: Interface with other departments to resolve issues related to appeals and initial denials, and communicate with Pre-Cert team and medical office personnel to obtain pertinent information.
  • Knowledge and Compliance: Maintain a thorough understanding of operations and business unit processes, including authorizations and referral requirements, and in/out-of-network insurances, as well as payer portal access and utilization.
Requirements:
  • Experience: Two years' recent experience in healthcare revenue cycle or prior authorizations for inpatient/outpatient, hospital/physician.
  • Skills: Experience in healthcare claims processing and proficiency with medical billing and remittance forms and processes, including 835 and 837 files, and UB04 and CMS-1500 (HCFA) forms.
  • Education: Medical terminology.
What We Offer:

At Accounting Now, we offer a dynamic and supportive work environment, competitive compensation, and opportunities for professional growth and development.


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