Denial Resolution Specialist II
Core
Reviewing, analyzing, and initiating action for complex denial resolution by communicating with payers, hospital departments, and patients.
Role type
Senior denial resolution specialist (healthcare billing)
Builds
Resolved accounts receivable and reduced future denials for a large health system
Domain
Healthcare revenue cycle management / Medical billing
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
denial root cause analysis, payer communication, claim correction and resubmission, Medicare/MassHealth system navigation, high-dollar claim resolution, audit support, appeal management, claim code interpretation, process improvement
Preferred skills
knowledge of revenue/condition/occurrence codes, coordination of benefits, cross-training facilitation
Technologies
Medicare FISS, MassHealth MMIS, payer websites
Responsibilities
Triaging denial root causes and executing next steps; Identifying trends to reduce future denials; Resolving high-dollar account denials (>100k); Correcting and resubmitting claims in Medicare and MassHealth systems; Conducting authorization research and rebilling; Corresponding with payers and patients to obtain resolution information; Documenting all actions and maintaining audit trails.
Seniority
Mid-Senior level, hands-on IC