Texas Licensed Clinical Denial Specialist

Job Summary

A company is looking for a Clinical Denial Management Specialist II.

Key Responsibilities

• Review, research, and resolve denial of professional claims related to coding and payer policies
• Prepare and submit appeals to payers based on guidelines and contact payers regarding denied claims
• Provide feedback on denial trends to leadership and reconcile expected payments

Required Qualifications, Training, and Education

• High School Diploma or equivalent
• 2 years of medical billing or collections experience
• Ability to work with clinical denials for complex services and strong knowledge of claims recovery rules
• Preferred coding certifications or degrees may substitute for experience
• Licenses and certifications such as CPC or CPMA are required upon hire