Medical-Denial Management Specialist

Established in 1970, Orthopedic Associates of Hartford, P.C. is one of the area’s largest orthopedic practices with office locations throughout greater Hartford. This hybrid position requires regular onsite attendance in Farmington, CT; candidates should be within commuting distance.

About the role

The Medical-Denial Management Specialist analyzes and resolves healthcare insurance claim denials by investigating reasons, preparing appeals, communicating with payers, and collaborating with billing staff to ensure proper reimbursement and prevent future denials. This role requires strong analytical, communication, and problem-solving skills, along with a thorough understanding of insurance policies, medical terminology, and healthcare billing procedures. Proficiency in multiple computer software programs and an understanding of insurance payment methodologies are essential. A positive “can-do” attitude and the ability to build relationships with internal and external customers are musts.

Responsibilities

• Follow policies and procedures, and perform timely and accurate follow-up on claims for resolution of outstanding balances.
• Participate in the collection and documentation of claims processing rules.
• Generate both electronic and hard-copy claims for submission.
• Obtain supporting documentation and other information required to ensure acceptance of claims.
• Interact and communicate effectively with interdepartmental units when necessary.
• Document account information pertaining to claims submission and resolution.
• Enter demographic data into the billing & collections software.
• Assume other duties and responsibilities as needed.

Requirements

• Two years of recent experience in medical collections and/or medical billing with result-oriented debt-collection skills.
• Familiarity with ICD-10 coding and Federal HIPAA regulations.
• Computer skills including Epic, electronic billing, Microsoft Word, Outlook, and Excel.
• Excellent written and verbal communication skills with a professional and courteous telephone manner.
• High school diploma.