Responsibilities
- Investigate and resolve rejected medical claims by analyzing denial codes and payer-specific feedback.
- Partner with coding, billing, and enrollment departments to detect and stop repeated claim rejections.
- Examine Explanation of Benefits, Electronic Remittance Advice documents, and coverage policies from LCD/NCD sources.
- Address claim denials tied to modifier usage, filing deadlines, coordination of benefits, and coding mismatches.
- Monitor timeframes for resolving denials, keep detailed logs, and support reporting through dashboards and metrics.
- Support the preparation of appeals and resubmissions with accurate and compliant documentation.
- Stay current on regulatory requirements from CMS, Medicare, Medicaid, and private insurance payers.
- Help develop and maintain internal denial resolution guides, standard operating procedures, and reference materials.
Benefits
- Flexible paid time off, available depending on geographic location
- Comprehensive health benefits including medical, dental, vision, and parental leave
Work Shift
Night shift conducted on-site
Weekdays
Monday to Friday
Employees will act in accordance with the organization’s information security policies, to include but not limited to protecting assets from unauthorized access, disclosure, modification, destruction or interference nor execute particular security processes or activities.
Employees must follow organizational information security policies, including safeguarding assets against unauthorized access, disclosure, alteration, destruction, or interference.
Employees will report to the information security office any confirmed or potential events or other risks to the organization.
Employees are required to report any actual or suspected security incidents or risks to the information security office.
Employees will be required to attest to these requirements upon hire and on an annual basis.
Employees must formally confirm compliance with these security requirements at hire and each year thereafter.
