Denials Resolution & Appeals Specialist

Baptist Health - Central Alabama; Montgomery (AL); On-site; USD 42,000 - 65,000; Full time

Job summary

Baptist Health - Central Alabama is seeking a Denials Management Specialist to validate dispute reasons, escalate variances to management, and generate appeals for denied or underpaid claims. The role entails resolving complex and aged accounts, researching payer contracts and regulations, and documenting collection activity.

The position requires knowledge of ICD-9/ICD-10 and CPT coding, plus strong MS Office skills, analytical abilities, and effective communication.

Qualifications

• High School diploma or equivalent required.
• Associates degree or higher preferred.
• Minimum of 3 years’ experience in hospital billing or medical office environment performing billing and/or collections.
• CRCR or CPAR certification preferred

Responsibilities

• Validate dispute reasons and escalate payment variance trends to management.
• Generate appeals for denied or underpaid claims.
• Resolve complex and aged accounts and review payer contracts and chargemaster.
• Document all pertinent collection activity accurately.
• Escalate issues to payer provider advocates and contracting teams as needed.

Skills

MS Office

Team leadership

Analytical thinking

Communication skills

Organization

Problem-solving

Education

High School diploma or equivalent

Associates degree or higher preferred

Tools

Billing software

ICD-9/ICD-10

CPT coding

Job description

Baptist Health - Central Alabama is seeking a Denials Management Specialist to validate dispute reasons, escalate variances to management, and generate appeals for denied or underpaid claims. The role entails resolving complex and aged accounts, researching payer contracts and regulations, and documenting collection activity.

The position requires knowledge of ICD-9/ICD-10 and CPT coding, plus strong MS Office skills, analytical abilities, and effective communication.