Denials Management Specialist

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

Job summary

Southwoods Health in Boardman, Ohio is hiring a Denials Management Specialist to handle correspondence with insurers, follow up on unpaid or denied claims, and drive timely payments through the appeals process. You will review denial worklists, contact carriers, file appeals with supporting documentation, and log all interactions in patient records, while maintaining regulatory compliance.

Strong communication, problem-solving, and knowledge of revenue cycle operations are essential;

Qualifications

• Completed training or courses in business office operations, computer applications, and medical terminology.
• Certification in collection or billing is highly preferred.
• Comprehensive knowledge of revenue cycle operations and resolving complex claim issues.

Responsibilities

• Review tasks, credit balances, and denial worklists on a daily/weekly basis.
• Contact insurance companies to determine the status of unpaid or denied accounts.
• Prepare, file, and submit formal insurance appeals with necessary documentation.
• Document all contact interactions in patient account records.
• Identify billing errors and report for policy corrections.
• Stay compliant with OSHA, ODH, BOP, TJC and related regulations.

Skills

Communication skills

Problem solving

Professional demeanor

Ethical conduct

Education

Business office operations training

Medical terminology training

Computer applications training

Tools

Billing software

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.

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