Denial Prevention Specialist

4 days ago


Scottsdale, Arizona, United States CND Life Sciences Full time
Job Description

The Denial Prevention Specialist will oversee the denial management process within CND Life Sciences, ensuring timely reimbursement and improving overall revenue cycle performance. This involves leading a team of specialists to identify, analyze, and resolve denied claims. The specialist will spearhead achieving and maintaining compliance with federal and state regulations through rigorous oversight of coding practices using ICD-10, CPT, and HCPCS coding systems.

Key Responsibilities:

  • Implement strategies to prevent claim denials at the source, focusing on areas like referral, pre-authorization, eligibility, and coding accuracy.
  • Manage and audit medical coding practices for accuracy and compliance with industry guidelines.
  • Analyze payer denials across various revenue cycle stages.
  • Compose clear and compelling appeals based on medical record reviews and relevant guidelines.
  • Provide expert guidance on complex coding issues and support billing staff with resolving coding-related queries.
  • Conduct regular audits of coding practices to identify and correct discrepancies.
  • Collaborate with billing, clinical services, market access, and patient access teams to optimize denial prevention strategies and enhance overall revenue cycle efficiency.

Requirements:

  • Minimum 5 years of experience in medical billing and denial management, with at least 3 years in a supervisory or management role.
  • Demonstrated knowledge of all insurance companies, HMOs, PPOs, Medicare, and other third-party payers.
  • In-depth knowledge of ICD-10, CPT, HCPCS coding systems and medical terminology.
  • Strong understanding of healthcare regulations, including HIPAA, CMS, and OIG guidelines.

Estimated Salary: $85,000 - $110,000 per year, depending on experience and qualifications.



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