Denial Management Specialist (Remote)

Job Summary

The Denial Management Specialist provides leadership and training within the RCM Department, under the direction of the RCM Manager. This is a full-time remote opportunity open to candidates who reside in any time zone.

Responsibilities

• Investigate, resolve, and appeal denied or underpaid insurance claims
• Analyze denial trends and payer behavior
• Maintain accurate documentation and follow-up activities
• Partner with Revenue Cycle, Utilization Management, Credentialing, Clinical, and Operations teams
• Monitor assigned denial work queues and productivity metrics
• Afford leadership coaching, oversight, support, and training for Revenue Cycle Management team members, as needed
• Work closely with payers and operation leads to troubleshoot and resolve claims
• Continuously provide improvements to systems and processes along with support to team members within the RCM Department
• Effectively communicate with our payors’ partners and Operation Leads
• Navigate claims appeals and special projects with payors
• Review all unbilled claims and outstanding A/R
• Process audit requests timely and accurately
• Take the lead on monitoring assigned projects to completion

Requirements

• High School diploma required
• Bachelor’s Degree in Finance, Accounting, Healthcare Administration, or related field preferred
• 5+ years in revenue cycle management, with at least 1 year in a supervisory or team lead role required
• Experience in Billing Software, Clearinghouse, Payor Portals, and Excel required

Skills

• Strong analytical and strategic thinking skills
• Excellent communication and interpersonal skills
• Ability to Identify complex problems and reviewing related information to develop and evaluate options and implement solutions
• Demonstrated ability to work independently and as part of a team in a fast-paced, dynamic environment
• Strong organizational skills and attention to detail, with the ability to manage multiple priorities and deadlines effectively

Benefits

LEARN Behavioral offers competitive compensation, a comprehensive benefits plan, including 401(k), personal time off, paid holidays, and tuition reimbursement. LEARN Behavioral is an Equal Opportunity Employer. Candidates must be presently eligible to work in the United States.