Claims Specialist ( Approval & Denial Management)

Role & responsibilities

Functions: Reasonable accommodation may be made to enable individuals with
disabilities to perform job-related functions.
• Review claims for assigned offices and ensure submission within a timely manner.
• Perform quality control checks on patient accounts for accurate billing.
• Review and analyze denial queues to identify outstanding claims and unpaid balances.
• Follow up on denied, underpaid or rejected claims with insurance companies to resolve billing
discrepancies and ensure proper reimbursement.
• Investigate and resolve any claim rejections or denials, including appealing or demanding
denied claims when necessary.
• Collaborate with the Insurance Verification team to ensure eligibility and coverage is
uploaded for patients, ensuring accurate billing information is obtained.
• Communicate with insurance companies, patients, and healthcare providers to gather
additional information required for claim processing.

Preferred candidate profile

Strong English proficiency skills (verbal & written) required.
• Knowledge of medical billing/collection practices.
• Knowledge of computer programs.
• Ability to operate a computer and basic office equipment.
• Ability to operate a multi-line telephone system.
• Ability to read, understand and follow oral and written instructions.
• Must be well organized and detail oriented.