Denials Mitigation Specialist I - Hybrid Claims & Appeals

MedStar Health; Northern (KY); Hybrid; USD 28,000 - 50,000; Full time

Job summary

MedStar Health’s Washington Hospital Center is seeking a Denials Mitigation Specialist for a full-time dayshift with a hybrid schedule (about 3 on-site days per week). You will review technical denials, manage appeals, and coordinate with Payor, Patient Access, and Hospital Ancillary departments to optimize reimbursement.

The ideal candidate has 1–2 years in a medical setting with insurance knowledge and CPT/ICD-10 coding, an HS diploma (AD optional), and relevant certifications; CHAA/CHAM/CRCS

Qualifications

• High School Diploma or GED required.
• Associate's degree preferred.
• 1-2 years of experience in a medical setting with strong insurance knowledge and medical coding.
• Patient Access, Prior Authorization and denials management experience preferred.
• CHAA, CHAM or CRCS preferred.
• Knowledge of CPT/ICD-10, UB04 and EOB.

Responsibilities

• Manage and resolve denials and appeals to ensure reimbursement.
• Follow up on denials, reconciliations and rebills; monitor timely follow up.
• Interpret and apply payer guidelines, submission rules and contract terms.
• Provide cross-coverage and report denial findings to management.
• Maintain references on coding, carriers, networks and credentialing.
• Use payer tools and eligibility tools as required.
• Create tracking and trending reports for denials.
• Support prior authorization denial reviews and related education.
• Distribute accounts and obtain insurance clearance with timely responses.
• Collaborate with Managed Care and payors to resolve payment issues.
• Participate in cadence planning for denial and appeal processing.
• Foster a collaborative team environment to mitigate denials.

Skills

Medical terminology

CPT/ICD-10 coding

Insurance knowledge

Verbal and written communication

Team collaboration

Education

High School Diploma or GED

Associate's degree preferred

Tools

UB04 knowledge

EOB understanding

Job description

MedStar Health’s Washington Hospital Center is seeking a Denials Mitigation Specialist for a full-time dayshift with a hybrid schedule (about 3 on-site days per week). You will review technical denials, manage appeals, and coordinate with Payor, Patient Access, and Hospital Ancillary departments to optimize reimbursement.

The ideal candidate has 1–2 years in a medical setting with insurance knowledge and CPT/ICD-10 coding, an HS diploma (AD optional), and relevant certifications; CHAA/CHAM/CRCS