Insurance Denial Specialist

Job Description

Job Description

Complete Care is a multi-disciplinary practice serving patients who have physical injuries as a result of trauma. Complete Care and its family of practices are characterized by core competencies of cultural, clinical and operational excellence. We strive to meet every patients' individual needs with skillfulness and professionalism.

Role Overview

We are seeking a detail-oriented and analytical Insurance Denial Specialist to join our growing team. In this role, you will be responsible for investigating and resolving denied, underpaid, or unresolved insurance claims. Your expertise will help ensure timely resolution, reduce denial rates, and support the financial health of our organization.

Key Responsibilities

Research and resolve denied, underpaid, or unresolved insurance claims

Collaborate with insurance carriers and counsel to appeal denials and negotiate adjustments

Monitor and report on billing metrics to identify trends and improve claim resolution times

Utilize AR, underpayment, and monthly reports to track claim status and ensure accuracy

Maintain accurate claim documentation for reporting and compliance purposes

Communicate insights on denial trends with the team and leadership for process improvements

Provide support to colleagues on complex denial cases and best practices

Stay updated on industry regulations, policies, and trends impacting claim management

Qualifications

Proven experience in insurance claims processing or denial management

Strong analytical and problem-solving skills

Excellent communication and interpersonal skills

Detail-oriented with a focus on accuracy and efficiency

Familiarity with healthcare insurance policies and procedures

Ability to provide language translation support (as needed) for effective patient communication

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