Hospital Denials Specialist, Robert Half

Hospital Denials Specialist

Robert Half

Location:

United States, Los Angeles

Category:

Health and Beauty

Contract Type:

Employment contract

Salary:

Not provided

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Job Description:

The Hospital Denials Specialist is responsible for reviewing, analyzing, and resolving denied or underpaid claims from insurance payers. This role requires strong analytical abilities, knowledge of healthcare billing processes, and an understanding of reimbursement practices to minimize financial risks and optimize revenue outcomes. You will collaborate with various stakeholders, including payers and internal departments, to research and appeal claim denials while ensuring compliance with all regulatory requirements.

Job Responsibility:

Analyze and review denied claims to determine the root cause and take corrective action
Prepare, submit, and track appeals for denied or underpaid claims in compliance with payer-specific guidelines and deadlines
Communicate with insurance companies to resolve denials, underpayments, or payment delays
Collaborate with internal departments, such as medical billing, coding, and clinical teams, to obtain necessary documentation for appeals submissions
Stay current on payer policies, coding guidelines, and reimbursement rules to ensure compliance
Identify any trends or patterns in claim denials and provide feedback to leadership for process improvement
Utilize billing and claims management software to track denials and prepare detailed reports on denial management metrics
Maintain strict adherence to HIPAA regulations and other applicable laws regarding patient data privacy and security

Requirements:

Minimum 2-3 years of experience in healthcare billing, reimbursement, or denial management, preferably in a hospital or similar setting
Proficiency with electronic medical records (EMR) systems and billing software, such as Epic, Cerner, or similar platforms
Strong understanding of medical terminology, coding (ICD-10, CPT, HCPCS), and payer reimbursement guidelines
Exceptional problem-solving and analytical skills with the ability to identify trends and recommend solutions
Excellent written and verbal communication skills to effectively interact with payers and internal teams
Strong organizational and time-management skills with the ability to prioritize and meet deadlines in a fast-paced environment

What we offer:

medical
vision
dental
life and disability insurance
401(k) plan

Additional Information:

Job Posted:

March 21, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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