Denial Resolution Specialist

Job Summary

Working remotely in a full-time capacity, the Denial Resolution Specialist will be responsible for reviewing and analyzing complex denial resolutions, communicating with payers, hospital departments, and patients to ensure effective resolution and minimize future denials.

Key responsibilities:

• Triages denial root causes and executes appropriate next steps
• Identifies trends and participates in interdepartmental strategies to reduce future denials
• Corresponds with third-party payers and hospital departments to gather necessary information for denial resolutions

Required qualifications:

• High School diploma or equivalent
• Four or more years of experience in health care billing functions
• Previous experience in the denial resolution process
• Advanced knowledge of claim form content and submission requirements
• Ability to navigate MassHealth and Medicare claims processing applications