Denials Management Specialist

Southwoods Health; Boardman (OH); On-site; USD 42,000 - 64,000; Full time

Job summary

Southwoods Health is seeking a Denials Management Specialist to oversee procedural denial resolution and proactive follow-up with insurance carriers. You will manage worklists, communicate with payers, file appeals, and document all interactions to expedite payments while maintaining compliance.

This full-time role requires training in medical terminology and billing practices, with certification preferred, and emphasizes accuracy, ethics, and professional communication in a fast-paced revenue

Qualifications

• Education/training in business office operations, computer applications, and medical terminology.
• Certification in collections or billing is highly preferred.
• Strong knowledge of revenue cycle operations and denial resolution.
• Excellent communication and problem-solving skills.

Responsibilities

• Worklist Management: Review tasks, credit balances, and denial worklists daily and weekly.
• Payer Correspondence: Contact insurance companies to determine status of unpaid or denied accounts.
• Documentation & Appeals: Prepare, file, and submit formal insurance appeals with required documentation.
• Account Logging: Detailed notes of all contact interactions in patient accounts.
• Claims & Resolutions: Mail claim forms with attachments, investigate credits, report billing errors.
• Industry Compliance: Monitor policy updates and ensure processes comply with agencies (OSHA, ODH, BOP, TJC).

Skills

Communication

Problem solving

Professionalism

Ethical conduct

Education

Business office training

Job description

Company: Southwoods Health

Location: Boardman, Ohio

Schedule: Full-time. Monday-Friday 8am-4:30pm.

About the Role

Southwoods Health is hiring a Denials Management Specialist. In this role, you will be responsible for corresponding with insurance carriers regarding aged, unpaid claims. The ideal candidate will work diligently to secure and expedite payments through proactive follow-up and the strategic appeals resolution process.

Essential Duties

• Worklist Management: Review tasks, credit balances, and denial worklists on a daily and weekly basis.
• Payer Correspondence: Contact insurance companies directly to determine the status of unpaid or denied accounts, and navigate online insurance websites efficiently.
• Documentation & Appeals: Prepare, file, and submit formal insurance appeals. Send necessary copies or supporting clinical documentation required by insurance carriers.
• Account Logging: Detailed note-taking of all contact interactions with insurance companies and patients within the patient’s account records.
• Claims & Resolutions: Mail insurance claim forms with required attachments, investigate insurance credit balances for resolution, and identify/report billing errors to the supervisor for policy corrections.
• Industry Compliance: Review insurance newsletters and websites regularly for policy updates. Ensure all processes maintain strict compliance with regulatory agencies (OSHA, ODH, BOP, TJC, etc.).

What You’ll Need (Qualifications)

• Education/Training: Completed training or courses in business office operations, computer applications, and medical terminology.
• Certification: Collection or billing certification is highly preferred.
• Core Knowledge: Comprehensive knowledge of operational aspects of the revenue cycle and proven measures to take in successfully resolving complex claim issues.
• Key Skills: Effective communication skills, professional problem-solving capabilities, and the ability to maintain a professional demeanor at all times backed by strong ethical principles.

Why Choose Southwoods?

At Southwoods, it's not just about the treatment, but how you're treated. Join our award-winning team today. #SWH