Denials Mitigation Specialist I - Hybrid Day Shift

MedStar Health; Maryland; Hybrid; USD 28,000 - 50,000; Full time

Job summary

MedStar Health in Maryland is seeking a Denials Mitigation Specialist for a full-time hybrid role with approx. 3 days on-site. You will review denials, manage appeals, and provide monthly status updates to the Denials Mitigation Supervisor.

The role supports training across Physician Practices, Patient Access, and Hospital Ancillary Departments to reduce denied claims. Qualifications include 1–2 years in a medical setting with insurance knowledge and coding; high school or GED, and prefer

Qualifications

• High School Diploma or GED required.
• Associate's degree preferred.
• 1-2 years experience in medical setting with strong insurance knowledge and medical coding.
• CHAA, CHAM or CRCS preferred.

Responsibilities

• Manage and resolve denials and appeals ensuring effective denial management and prompt reimbursement.
• Follow up on returned claims correspondence, denials account reconciliations and rebills. Monitors for timely follow up.
• Interpret and apply insurance payer guidelines, claim submission rules and contract terms.
• Provide cross-coverage for team members and maintain regular communication with management about denial findings.
• Keep organized references on coding insurance carriers, managed care networks and credentialing.
• Uses insurance tools, Payer websites and other eligibility tools as required.
• Deliverables include creation of tracking and trending reports with scope/responsibility of denials.
• Special consideration of prior authorization denials will include department responsibility reviews and education on referrals or other findings that will allow reimbursement to hospital.
• Distributes accounts to outpatient departments, responsible for obtaining insurance clearance with expectation that department responds with authorization or reason for no authorization. Tracks and trends all responses from these departments. Monitors for timely follow up.
• Works with the Managed Care Department and insurance companies to resolve insurance payment issues. Attends Payor meetings to review findings and coordinate policy reviews.
• In collaboration with internal and external colleagues, create cadence of timelines for denial and appeal processing and follow up.
• Fosters a collaborative environment and promotes a team approach to resolution of denials and mitigation plans.

Skills

Medical terminology

CPT/ICD-10 coding

Verbal and written communication

Basic computer skills

UB04 & EOB knowledge

Payer applications/billing

Education

High School Diploma or GED

Associate's degree

Job description

MedStar Health in Maryland is seeking a Denials Mitigation Specialist for a full-time hybrid role with approx. 3 days on-site. You will review denials, manage appeals, and provide monthly status updates to the Denials Mitigation Supervisor.

The role supports training across Physician Practices, Patient Access, and Hospital Ancillary Departments to reduce denied claims. Qualifications include 1–2 years in a medical setting with insurance knowledge and coding; high school or GED, and prefer