Denial Specialist

  • location: Fresno, CA
  • type: Temp to Perm
  • salary: $17 - $19 per hour
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job description

Denial Specialist

Under the supervision of the Insurance Department Supervisor, ensures the efficient operation and effective
reimbursement of third party account receivables by researching accounts, refiling or appealing claims,
submitting additional medical documentation and tracking account status by monitoring and analyzing
assigned unresolved third party accounts. This position initiates contacts and negotiates appropriate resolution
(internal and external) as well as receives and resolves inquiries and correspondence from third parties and
patients. The ability to analyze, audit and reconcile an account is critical to this position. Processes in the
claims resolution may vary based on clients' needs and/or contract. This position follows-up on aged accounts
receivable to help ensure continuity of cash flow and to help secure resolution of account balances.

1. Initiates contact with guarantors/third party payer's to collect on outstanding receivables
2. Reviews, monitors and maintains accounts receivable at an acceptable level
3. Review and work denial referrals; for early identification of root cause of denial; preliminary determination
whether denial can be overturned; resolve denials in timely manner.
4. Ensures that all Third Party Payor claim filing deadline appeals are submitted timely and efforts to resolve
claim denials for timely filing are exhausted prior to submitting as a write off or patient responsibility (This will
vary by project.)
5. Monitor accounts for updates on claim status, and review of payment
6. Request and initiate the billing or re-bill of claims
7. Inform supervisor of trends noticed when working insurance inventory
8. Interpret hospital contract and/or fee schedules to identify underpayments needing additional follow-up.
(Depending on assigned project)
9. Recognizing bucket balance liability and transferring to appropriate for billing purposes as it pertains to
insurance liability and/or patient
10. Identify problematic accounts early Reports posting issues and trends to appropriate management
personnel and works collaboratively to develop solutions
11. Overcomes obstacles by using effective information gathering and problem solving methods.
12. Documents all follow-up activities in CUBs and/or Host systems.
13. Escalates claim resolution to management when necessary.
14. Posting of all pre-determined adjustments within the hospital system (non-Houston offices)
15. Demonstrates the willingness and ability to work collaboratively with other key internal and external staff
(including client if necessary) to obtain necessary information to address collections issues
16. Works on assigned claims and completes all necessary activity as defined in departmental policies and

Working hours: 7:00 AM - 4:30 PM

1. Ability to analyze, audit and reconcile accounts
2. Knowledgeable in all aspects of insurance reimbursement
3. Outstanding listening, communication, problem-solving, and research skills
4. Good Microsoft Outlook, Excel, and Word skills
5. Customer service experience demonstrating compassion and concern
6. Knowledge of government, commercial, worker's comp and managed care reimbursement guidelines
7. Familiarity with all federal, state and local legal aspects of collection activities
8. Ability to communicate effectively both oral and written and good interpersonal skills
9. Ability to work well under pressure and multi-task routinely

High School


HS Diploma or Equivalent

If you have the qualifications required, please apply to this job posting and send your resume to

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