California Licensed Denial Prevention Specialist

Job Summary

A company is looking for a Denial Prevention Specialist in the Revenue Cycle.

Key Responsibilities

• Analyze claim edits, rejections, and denial data to identify trends
• Conduct root-cause analysis for denials and develop preventive action plans
• Prepare monthly denial-prevention reports and maintain tracking dashboards

Required Qualifications

• High school diploma required; associate or bachelor's degree preferred
• 3-5 years of healthcare revenue cycle management experience, preferably in pain management or Workers' Compensation billing
• Strong experience with denial management and payer guidelines
• Knowledge of CPT/HCPCS coding and California Workers' Compensation regulations
• Advanced proficiency in Microsoft Excel and experience with multiple EHR/Practice Management systems