Denials Specialist

A company is looking for a Denials Specialist responsible for managing claims disputes and appeals.

Key Responsibilities

Validate denial reasons and ensure accurate coding in the DCM system

Generate appeals based on dispute reasons and payer contract terms

Research contract terms and compile documentation for appeals

Required Qualifications

High School Diploma or equivalent; some college coursework preferred

3 - 5 years of experience in a hospital business environment, focusing on billing and / or collections

Intermediate understanding of Explanation of Benefits (EOB) and Managed Care Contracts

Intermediate knowledge of hospital billing form requirements (UB-04)

Intermediate understanding of ICD-9, HCPCS / CPT coding, and medical terminology