The Denials and Appeals Specialist is responsible for reviewing denied claims and carrying out the appeals process. Works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence. Knowledgeable of state and federal laws that relate to payor contracts and appeals. Maintains and monitors integrity of the claim development and submission process.

Required Skills

1. Ten-key by touch required.
2. Knowledgeable of Patient Management and Patient Accounting systems.
3. Excellent customer service to effectively communicate with internal and external customers.
4. Analytical ability to comprehend, interpret and explain contract terms.
5. Excellent Financial analytical skills.
6. Excellent oral and written communication skills.
7. Detail oriented ability to set and meet deadlines, and support multiple projects.
8. Solid decision making skills.
9. Ability to work independently as well as in a team environment.
10. Knowledge of computers and accounting systems
11. Proficiency with Microsoft Office software.

Required Experience

Work Experience:

Minimum of five years’ experience in healthcare billing, denials management, claims or appeals.

At least two years’ experience using computer programs for tracking denials and appeals.

Experience working with electronic health records and billing software, particularly Cerner.

License/Registration/Certification:

None.

Education and Training:

**** Bachelor’s degree in healthcare administration, business, or a related field preferred (may be substituted with 5 years of experience in denials and appeals management).

1. Ten-key by touch required.
2. Knowledgeable of Patient Management and Patient Accounting systems.
3. Excellent customer service to effectively communicate with internal and external customers.
4. Analytical ability to comprehend, interpret and explain contract terms.
5. Excellent Financial analytical skills.
6. Excellent oral and written communication skills.
7. Detail oriented ability to set and meet deadlines, and support multiple projects.
8. Solid decision making skills.
9. Ability to work independently as well as in a team environment.
10. Knowledge of computers and accounting systems
11. Proficiency with Microsoft Office software.