Overview
Denials Specialist – Remote Jobs in United States at RemoteHunter
Title: Denials Specialist – Remote
Company: RemoteHunter
Location: United States
1. About Our Client:
The organization operates in the healthcare industry, focusing on improving financial and clinical performance for healthcare providers. With over 30 years of experience and presence in more than 135 local regions nationwide, the program supports clients in transitioning from volume-based to value-based care. It aims to enhance patient experience and improve healthcare quality, cost, and access.
2. About the Opportunity:
The Denials Specialist is responsible for validating dispute reasons following Explanation of Benefits reviews, escalating payment variance trends to leadership, and generating appeals for denied or underpaid claims. This role directly impacts the accuracy and efficiency of claims processing, ensuring appropriate reimbursement and resolution of payment disputes.
3. Responsibilities:
• Validate denial reasons and ensure accurate coding in the denial case management system
• Coordinate with clinical resources for consultations or referrals when needed
• Generate appeals based on dispute reasons and payor contract terms, including online reconsiderations
• Follow payor-specific guidelines for submitting appeals
• Escalate appeals that have been exhausted for further resolution
• Support payer-related projects as assigned
• Research contract terms and compile supporting documentation for appeals and adjudication issues
• Determine corrective actions and appropriately code and route accounts
• Report denial or payment variance trends to leadership for payor escalation
4. Requirements:
• Intermediate understanding of Explanation of Benefits forms, Managed Care Contracts, and relevant federal and state requirements
• Intermediate knowledge of hospital billing form (UB-04) requirements
• Intermediate understanding of ICD-9, HCPCS/CPT coding, and medical terminology
• Intermediate skills in Microsoft Word and Excel
• Advanced business letter writing with correct grammar and punctuation
• High School Diploma or equivalent; some college coursework preferred
• 3 to 5 years of experience in hospital billing or collections
5. Pay Range and Compensation Package:
• Pay range: $18.60 to $28.00 per hour, depending on location, qualifications, and experience
• Position may qualify for a signing bonus for new hires, subject to employment status
• Time and a half pay for observed holidays
6. Benefits & Perks:
• Medical, dental, vision, disability, and life insurance
• Paid time off including vacation and sick leave, accruing at approximately 12 days per year
• 401k plan with up to 6% employer match
• Ten paid holidays per year
• Health savings accounts and flexible spending accounts for healthcare and dependents
• Employee assistance and employee discount programs
• Voluntary benefits such as pet, legal, accident, critical illness, long-term care, elder and childcare, AD&D, auto, and home insurance
• Paid leave compliant with Colorado Healthy Families and Workplaces Act for Colorado employees
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.