Claims Denials & Revenue Recovery Specialist

Gastromed,-LLC; Coral Gables (FL); On-site; USD 26,000 - 33,000; Full time

Benefits offered by this job

100% employer-paid health insurance

Competitive salary

Job summary

Gastromed,-LLC is seeking a Denials Management & Claims Resolution Specialist in Coral Gables, FL to identify, investigate, appeal, and resolve denied or rejected insurance claims and maximize reimbursement. The role collaborates with providers, coding, billing, and payer representatives to address claim issues andImprove revenue cycle performance.

The position requires 2+ years in medical billing/denial management, English/Spanish bilingual preferred, and proficiency with EHR and billing

Qualifications

• High School Diploma required.
• Minimum of two (2) years of experience in medical billing, collections, denial management, or claims resolution.
• Experience with insurance appeals, denial management, and payer follow-up required.
• Knowledge of Medicare, Medicaid, and commercial insurance billing guidelines.
• Bilingual English/Spanish preferred; must be able to read, write, and speak English.
• Basic computer knowledge including Microsoft Word, Excel, Electronic Health Records (EHR), billing software, payer portals, email, and e-fax systems.

Responsibilities

• Investigate, analyze, and resolve denied, rejected, and underpaid insurance claims.
• Prepare, submit, and track first-level and subsequent insurance appeals within payer deadlines.
• Review medical records, coding, documentation, and billing information to determine the cause of claim denials.
• Identify denial trends and recommend corrective actions to reduce future denials and improve reimbursement.
• Communicate with insurance companies to resolve claim payment issues and obtain claim status updates.
• Work collaboratively with providers, coders, billers, and authorization staff to resolve documentation, coding, and billing deficiencies.
• Request claim adjustments, corrected claims, or reconsiderations as appropriate to resolve outstanding balances.
• Monitor accounts receivable and prioritize denied claims based on aging and financial impact.
• Maintain accurate and detailed account notes and documentation within the billing system.
• Ensure all denial and appeal activities comply with payer guidelines and regulatory requirements.
• Prepare denial management and appeals activity reports for the Revenue Cycle Manager.
• Assist with identifying process improvements to enhance claim acceptance rates and reduce reimbursement delays.
• Perform other duties as assigned by management.

Skills

Denials management

Claims resolution

Insurance appeals

Payer follow-up

HIPAA compliance

Analytical skills

Organizational skills

Communication skills

Independent work

Confidentiality

Education

High School Diploma

CPC certification

Tools

EHR systems

Billing software

Payer portals

Microsoft Word/Excel

Job description

Gastromed,-LLC is seeking a Denials Management & Claims Resolution Specialist in Coral Gables, FL to identify, investigate, appeal, and resolve denied or rejected insurance claims and maximize reimbursement. The role collaborates with providers, coding, billing, and payer representatives to address claim issues andImprove revenue cycle performance.

The position requires 2+ years in medical billing/denial management, English/Spanish bilingual preferred, and proficiency with EHR and billing