Denial Prevention Specialist

We are seeking a high-caliber Denial Prevention Specialist to join a premier medical institution. This role is designed for a self-motivated professional with a deep background in Physician Billing and a proven track record of successfully managing the full appeals process. You will be responsible for navigating the complexities of insurance claim denials, identifying payment trends, and maximizing collections for a major healthcare system.

Location: 100% Remote (Must reside in the Greater DFW, TX area)

Compensation: $22.00/hr

Contract Type: 6-Month Contract

Schedule: 8-hour shift with a flexible start time between 6:00 AM - 9:00 AM

Key Responsibilities

• Denial Analysis & Appeals: Review Explanation of Benefits (EOB) to determine claim management, analyze payer denials by groupers, and prepare/submit formal appeals.
• Claim Recovery: Contact insurance carriers (Managed Care, Commercial, Medicare, and Medicaid) to resolve outstanding balances and investigate underpaid claims.
• Account Stewardship: Make necessary financial adjustments based on plan reimbursement and resolve complex unpaid claims through assertive collection efforts.
• Liaison Duties: Act as a vital link between clinical departments and the management team to resolve billing discrepancies.
• Documentation: Perform quick and accurate alpha/numeric data entry while ensuring all communications reflect a professional and courteous image.

Required Qualifications

• Experience: Minimum of 2 years of recent experience in medical claims recovery and/or collections.
• Technical Expertise: Direct experience in Physician Billing specifically involving the drafting and submission of medical appeals.
• Payer Knowledge: Strong understanding of billing regulations and requirements for Medicare, Medicaid, and Commercial insurance plans.
• Communication: Fluent in reading, writing, and speaking English; must be able to communicate assertively and confidently with patients and carriers.
• Education: High School Diploma required; Associate's Degree preferred.

Technical Skills & Abilities

• Proficiency in Medical Billing, Accounts Receivables, and/or Collections within a healthcare environment.
• Strong analytical skills to resolve intricate unpaid claims and identify systemic payment trends.
• Ability to handle high-volume workloads in a fast-paced, production-oriented environment.
• Knowledge of CMS 1500, ICD-9/10, and CPT coding is highly preferred.

Remote Work Requirements

This is primarily a Work From Home (WFH) opportunity; however, candidates must live within the Greater DFW area to facilitate the following:

• Equipment pickup and office meetings.
• Onsite training or team-building events as requested by leadership.
• A dedicated, private workspace suitable for handling sensitive healthcare information.