Billing Denials Specialist
Overview
The Billing Denial Specialist is responsible for proactively reviewing, researching, and resolving insurance claim denials to ensure timely reimbursement and minimize revenue loss for the Practice. This role plays a critical part in the revenue cycle by identifying denial trends, filing appeals, correcting claim issues, and working denials through to resolution. The ideal candidate is highly organized, detail-oriented, dependable, and able to work independently with minimal supervision. This individual must be a self-starter who takes initiative, remains proactive, and does not require constant direction to manage responsibilities effectively. This is a fully remote position. Only qualified applicants currently residing in Florida will be considered for employment.
Key Responsibilities
Review denial reports daily and actively work all assigned insurance claim denials to resolution. Research denied, underpaid, and rejected claims to determine root cause and appropriate corrective action. Submit corrected claims, reconsiderations, and appeals in a timely manner. Communicate with insurance carriers regarding claim status, appeals, and reimbursement issues. Identify denial trends and escalate recurring payer or workflow issues to leadership. Maintain accurate and detailed documentation of all follow-up activities within the practice management system. Work collaboratively with billing, coding, authorizations, scheduling, and clinical teams to resolve claim issues. Ensure compliance with payer guidelines, billing regulations, and practice policies. Prioritize workload effectively to meet productivity and aging goals. Follow through on unresolved claims until final determination or payment is received. Assist with special revenue cycle projects and additional duties as assigned. Other duties as assigned. This job description is not designed to cover or contain a comprehensive list of activities, duties, or responsibilities that are required of the employee. They may change, or new ones may be assigned at any time with or without notice.
Qualifications
Minimum of 3 years of medical billing and denial management experience preferred Experience working with commercial insurance, Medicare, Medicaid, and managed care payers Strong understanding of medical billing, claims processing, EOBs, appeals, and denial resolution Knowledge of CPT, ICD-10, and HCPCS coding preferred Experience with EMR and practice management systems preferred Proficiency with Microsoft Office and payer portals Ability to manage multiple priorities and meet deadlines. Knowledge of HIPAA regulations and ability to maintain confidentiality. Strong analytical and problem-solving skills Excellent attention to detail and organizational skills Self-motivated, proactive, and dependable Strong written and verbal communication skills Ability to identify opportunities for process improvement and workflow efficiency Professional, positive, and team-oriented attitude Benefits 100% employer-paid medical insurance for employees 401(k) with company match and employer-funded profit sharing Four-day work week (Monday – Thursday), supporting strong work/life balance Paid holidays and Paid Time Off (PTO) A collaborative, team-oriented culture with strong support and a shared commitment to exceptional patient care Physical Demands Prolonged periods of sitting at a desk and working on a computer. Ability to use hands and fingers to handle, control, or feel objects and operate a keyboard. Occasional standing, walking, bending, and reaching as needed to access files or office equipment. Visual acuity to read and enter data accurately into electronic systems. Hearing and speech ability sufficient to clearly communicate with patients, coworkers, and insurance representatives in person, over the phone, and through electronic communication systems. Employment Opportunity Sarasota Arthritis Centers provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Apply To This Job