Job Description
Description Overview A Healthcare Claims Denial Management Specialist is responsible for identifying, analyzing, and resolving denied or underpaid medical insurance claims. This role ensures accurate reimbursement by working with payers, internal billing teams, and healthcare providers while maintaining compliance with regulatory and payer-specific requirements. Key Responsibilities Denial Review
7:30 AM
Log in and pull the overnight denial queue. Your worklist shows 40–80 claims flagged by the payer in the last 24 hours. Sort by do…
8:00 AM
Start working the queue. For each denial, you're reading the remittance advice, identifying the denial reason code (CO-4, CO-50, C…
9:30 AM
Hit a complex medical necessity denial from a Medicare Advantage plan. Open the patient chart, pull the clinical documentation, an…
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