Job Description
At Houston Methodist, the Denials Management Specialist (DMS) position is responsible for reviewing, coordinating, and monitoring the clinical denial management and appeals process in a collaborative environment with Central Business Office (CBO) management and clinical partners at the various Houston Methodist facilities. This position combines clinical, business, and regulatory knowledge and ski
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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