Job description:

JOB DESCRIPTION:

Clinicspectrum is seeking a motivated and detail-oriented Insurance Denial Specialist to join our team. The ideal candidate will have a strong understanding of medical billing processes, insurance policies, and denial management to ensure timely and accurate resolution of denied claims. This role is critical in maximizing reimbursements for healthcare providers by identifying, analyzing, and rectifying claim denials efficiently.

QUALIFICATIONS:

• Proven experience in medical billing, insurance denial management, or revenue cycle processes.
• Familiarity with medical terminology, CPT/ICD coding, and insurance payer rules.
• Strong problem-solving skills with attention to detail.
• Excellent verbal and written communication skills.
• Proficiency in using medical billing software and Microsoft Office applications.
• Ability to work independently and in a team environment to meet deadlines.

• Analyze and resolve insurance claim denials, including underpayments and rejections.
• Collaborate with insurance carriers to research and resolve issues preventing claim payment.
• Appeal denied claims with accurate and comprehensive documentation to ensure successful outcomes.
• Track and document all actions taken on denied claims within the billing system.
• Communicate with healthcare providers, patients, and insurance representatives to clarify billing discrepancies.
• Identify trends and provide feedback to improve claim submission processes and reduce denials.
• Maintain up-to-date knowledge of insurance guidelines, CPT/ICD codes, and payer-specific requirements.
• Work closely with the revenue cycle team to optimize reimbursement processes and ensure compliance with regulations.