Claims Denial Managment/AR Specialist

OrthoMed Anesthesia; Addison (TX); On-site; USD 50,000 - 70,000; Full time

Job summary

OrthoMed Anesthesia in Addison, TX seeks a Healthcare Claims Denial Management Specialist to identify, analyze, and resolve denied or underpaid medical claims. Responsibilities include reviewing claims, communicating with insurance, and ensuring compliance with regulations.

The ideal candidate will have 2–4 years of experience in medical billing and possess strong analytical and communication skills. Familiarity with CPT, HCPCS, and ICD-10 coding is preferred. The role requires proficiency in EMR/EHR systems and billing software.

Qualifications

• 2–4 years in medical billing, claims processing, or denial management.
• Strong attention to detail and problem-solving skills.
• Excellent verbal and written communication skills.

Responsibilities

• Review and analyze denied, underpaid, and rejected medical claims.
• Communicate directly with insurance representatives.
• Generate denial reports and analyze denial metrics.

Skills

Revenue cycle processes

CPT/HCPCS and ICD-10 coding

Insurance payer rules

Medical terminology

Analytical abilities

Communication skills

Organizational skills

Tools

EMR/EHR systems

Billing software

Job description

Job Location: ADDISON, TX 75001

Overview

A Healthcare Claims Denial Management Specialist is responsible for identifying, analyzing, and resolving denied or underpaid medical insurance claims. This role ensures accurate reimbursement by working with payers, internal billing teams, and healthcare providers while maintaining compliance with regulatory and payer-specific requirements.

Key Responsibilities

Denial Review & Resolution

• Review and analyze denied, underpaid, and rejected medical claims to determine root causes.
• Correct claim errors, update coding or documentation as needed, and resubmit claims to payers within required timeframes.
• Follow up with insurance companies to resolve outstanding denials and secure payment.

Payer Communication & Documentation

• Communicate directly with insurance representatives to verify claim status, obtain clarification, and resolve discrepancies.
• Maintain detailed documentation of actions taken, correspondence, and outcomes in billing and practice management systems.

Root Cause Analysis & Prevention

• Identify denial patterns or trends across payers, coding categories, or service lines.
• Collaborate with coding, billing, and clinical teams to prevent future denials through process improvements, training, or documentation enhancements.

Appeals Management

• Prepare and submit formal appeals with supporting medical records, coding references, and payer policy documentation.
• Track appeal outcomes and ensure compliance with appeal deadlines and payer regulations.

Compliance & Quality Assurance

• Ensure all claim corrections and submissions comply with federal, state, and payer-specific regulations.
• Stay up to date on payer policy changes, coding guidelines (CPT, HCPCS, ICD-10), and industry best practices.

Reporting & Performance Tracking

• Generate denial reports, analyze denial metrics, and provide insights to leadership.
• Monitor key performance indicators (KPIs) such as denial rate, appeal success rate, and days in accounts receivable (A/R).

Required Skills & Qualifications

• Experience: 2–4 years in medical billing, claims processing, or denial management (healthcare or payer environment).
• Knowledge:
  • Revenue cycle processes
  • CPT/HCPCS and ICD-10 coding
  • Insurance payer rules (commercial, Medicare, Medicaid)
  • Medical terminology
• Technical Skills: Proficiency with EMR/EHR systems, clearinghouses, and billing software.
• Analytical Abilities: Strong attention to detail, ability to identify trends, solve problems, and interpret payer policies.
• Communication: Excellent verbal and written communication skills for working with payers, providers, and internal teams.
• Organizational Skills: Ability to manage multiple priorities, meet deadlines, and maintain thorough records.

Preferred Qualifications

• CPC, CPB, or other AAPC/AHIMA certification.
• Experience with high-volume claims environments.
• Familiarity with appeals and audit processes.