Professional Billing Denials Specialist

Quick Facts

• Role: Professional Billing Denials Specialist
• Focus: Claim edits, denials follow-up, and third-party payer receivables

Description

The Professional Billing Denials Specialist supports clean, complete, and accurate claim submissions while adhering to corporate compliance and regulatory standards. The role resolves claim edits, manages denials and appeals with root-cause analysis to reduce future denials, and follows up to collect outstanding third-party payer receivables. HIPAA privacy compliance and achievement of productivity/quality targets are core to the position.

Responsibilities

• Resolve claim edits and ensure timely, outbound compliant claim submissions
• Meet productivity, quality, and reporting standards for edits and claim handling
• Follow up on denials and appeals and perform root-cause analysis to overturn denials
• Communicate with third-party payers regarding outstanding receivables (statements, letters, emails, faxes, portal mail)
• Support third-party accounts receivable operations across commercial, government, and specialty AR categories
• Perform daily reviews of work lists to ensure accounts are completed
• Use government, commercial, and regulatory guidelines for collections and recommend write-offs with documentation
• Maintain HIPAA privacy standards for patient health information
• Identify customer, system, and process improvement opportunities
• Use hospital mainframe menus/pathways and external software applications; report software/hardware issues
• Participate in testing for assigned software applications and verify field integrity
• Assist with special projects and other duties as assigned; attend assigned training
• Provide excellent customer service through oral and written communication