Denials & Appeals Specialist II - Billing Expert

DHR Health; Edinburg (TX); Vor Ort; USD 38.000 - 52.000; Vollzeit

Zusammenfassung

DHR Health in Edinburg, TX is seeking a Billing and Collections Specialist II for RMF Denials Management. This role involves quality assurance on denied claims, drafting payer appeals using clinical indicators and Official Coding Guidelines, and supporting training across Revenue Cycle teams.

The position requires knowledge of CPT/HCPCS, ICD-10, medical terminology, and strong Microsoft Office skills. Bilingual English/Spanish is preferred and prior healthcare billing experience is valued.

Qualifikationen

• High School Diploma or GED required.
• 2–3 years in denial management, utilization review or prior authorization in a hospital or healthcare system.
• Experience in healthcare billing and reimbursement.
• Knowledge of CPT/HCPCS, ICD-10 codes and medical terminology.
• Familiarity with EMR workflows and payer portals.

Aufgaben

• Promotes mission, vision and values.
• Demonstrates denial and appeals proficiency.
• Drafts appeal letters with necessary information.
• Follow-up on insurance accounts and claim status.
• Adheres to governmental billing guidelines.
• Uses software to verify eligibility and status of claims.
• Responds to insurance carrier correspondence in a timely manner.
• Collaborates with internal teams to resolve denial issues.

Kenntnisse

Customer service

Bilingual English/Spanish

Healthcare reimbursement knowledge

Ability to interpret contract language

Microsoft Office Suite

Excel proficiency

EMR system workflows

Denials and appeals proficiency

Strong communication skills

Ausbildung

High School Diploma/GED

2-3 years denial management experience

Tools

Microsoft Office

Excel

Jobbeschreibung

DHR Health in Edinburg, TX is seeking a Billing and Collections Specialist II for RMF Denials Management. This role involves quality assurance on denied claims, drafting payer appeals using clinical indicators and Official Coding Guidelines, and supporting training across Revenue Cycle teams.

The position requires knowledge of CPT/HCPCS, ICD-10, medical terminology, and strong Microsoft Office skills. Bilingual English/Spanish is preferred and prior healthcare billing experience is valued.