[Hiring] Medical Claims Denial & Appeals Specialist @CU Medicine

Role Description

We are seeking a highly motivated Medical Claims Denial & Appeals Specialist to join our Accounts Receivable Resolution team. This job can be performed 100% remotely and out of state candidates will be considered.

The Specialist is primarily responsible for resolving all insurance claim denials for assigned departments to enhance revenues for CU Medicine providers. The individual in this position will generate effective written appeals to carriers using well-researched logic. Denial Specialists are independently accountable for the denial resolution for their assigned divisions.

• Appeal denials through coding review, contract review, medical record review and carrier interaction.
• Demonstrate a high level of expertise in the management of complicated denied claims.
• Deploy analytical approach to resolve denials and recognize trends/patterns in order to proactively resolve recurring issues.
• Utilize a multitude of resources to ensure correct appeal processes are followed.
• Communicate identified denial patterns to management.
• Prioritize and process large volume of denials and maintain high quality of work.
• Serve as an escalation point for unresolved denial issues.
• Inform team members of payer policy changes.
• Assist in training new employees as assigned.
• Collaborate on special projects as needed.

Qualifications

• 3-5 years experience in medical practice billing with exposure to working with denials, appeals, insurance collections and related follow-up.
• Bachelor’s degree in a related field is strongly preferred.
• Must have ICD-10 and CPT coding assessment skills.
• CPC certification is preferred.
• Intermediate PC software experience required.
• Advanced verbal and written communication skills are essential.
• Must demonstrate a solid understanding and ability to apply contract language in conjunction with a comprehensive understanding of claims denial appeal logic.

Requirements

• All applications MUST be submitted via our website.
• You may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation.
• You will not be penalized for redacting or removing this information.

Benefits

• Generous leave.
• Health plans.
• Retirement contributions which take your total compensation beyond the number on your paycheck.