Denials Specialist - Remote

This is a Fully Remote Job About Our Client:The organization operates within the healthcare industry, supporting clients in enhancing financial and clinical performance across over 135 local regions nationwide. It addresses challenges related to transitioning from volume to value-based care, improving patient healthcare experience, and optimizing quality, cost, and access to healthcare services. About the Opportunity:The DENIALS SPECIALIST is responsible for validating dispute reasons following Explanation of Benefits (EOB) reviews, managing appeals for denied or underpaid claims, and escalating payment variance trends to leadership. This role is essential in ensuring accurate claim processing and effective resolution of payment discrepancies, directly impacting the organization's financial accuracy and client satisfaction. Responsibilities:Validate denial reasons and ensure accurate coding in the Dispute Case Management (DCM) system.Coordinate with clinical resources for consultations or account referrals as needed.Generate appeals based on dispute reasons and payer contract terms, including online reconsiderations.Follow specific payer guidelines for appeal submissions.Escalate unresolved appeals for resolution.Participate in payer-related projects as directed.Research contract terms and compile supporting documentation for appeals and adjudication issues.Determine corrective actions and update the DCM system accordingly.Escalate denial or payment trends to leadership for further payer escalation. Requirements:High school diploma or equivalent; some college coursework preferred.3 to 5 years of experience in hospital billing or collections.Intermediate understanding of Explanation of Benefits forms, managed care contracts, and federal/state requirements.Intermediate knowledge of hospital billing forms (UB-04).Intermediate understanding of ICD-9, HCPCS/CPT coding, and medical terminology.Intermediate skills in Microsoft Word and Excel.Advanced business letter writing skills with correct grammar and punctuation. Pay Range and Compensation Package:Pay: $18.60 to $28.00 per hour, depending on location, qualifications, and experience.Position may be eligible for a signing bonus for qualified new hires.Observed holidays receive time and a half. Benefits & Perks:Medical, dental, vision, disability, and life insurance.Paid time off (minimum 12 days per year).401(k) plan with up to 6% employer match.Ten paid holidays per year.Health savings accounts and flexible spending accounts.Employee assistance and discount programs.Voluntary benefits including pet, legal, accident, critical illness, long term care, and other insurance options.Paid leave in accordance with Colorado’s Healthy Families and Workplaces Act for Colorado employees. Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.