Medical-Denial Management Specialist (this position is not remote)

Orthopedic Associates of Hartford; Farmington (CT); On-site; USD 55,000 - 70,000; Full time

Job summary

A healthcare organization located in Farmington, Connecticut, is seeking a Medical-Denial Management Specialist. The role focuses on analyzing healthcare insurance claim denials, preparing appeals, and collaborating with billing staff to ensure reimbursement. Ideal candidates should possess strong analytical, communication, and problem-solving skills, along with proficiency in Epic and billing software. A positive attitude and the ability to maintain relationships with internal and external customers are essential, alongside an understanding of medical terminology and insurance payment methodologies.

Qualifications

• Thorough understanding of insurance policies and medical terminology.
• Experience in healthcare billing procedures.
• Ability to build relationships with customers.
• Ability to build relationships with internal and external customers to promote timely resolution of outstanding claims

Responsibilities

• Timely and accurate follow up on claims for outstanding balances.
• Participate in documenting claims processing rules.
• Generate electronic and hard copy claims for submission.
• Obtain necessary documentation for claim acceptance.
• Communicate effectively with interdepartmental units.
• Documents account information pertaining to claims submission and resolution.
• Enters demographic data into the billing & collections software.
• Assumes other duties and responsibilities as needed.

Skills

Strong analytical skills

Communication skills

Problem-solving skills

Team player

Detail oriented

Positive attitude

Tools

Billing & collections software

Epic

Job description

Established in 1970, Orthopedic Associates of Hartford, P.C., is one of the areas largest orthopedic practices with office locations throughout greater Hartford. Our growing practice is currently seeking a Medical-Denial Management Specialist with Epic experience to join our Billing & Collections team in our Farmington, Connecticut business office. The Medical-Denial Management Specialist analyzes and resolves healthcare insurance claim denials by investigating reasons, preparing appeals, communicating with payers, and collaborating with billing staff to ensure proper reimbursement and prevent future denials. This role requires strong analytical, communication, and problem-solving skills, along with a thorough understanding of insurance policies, medical terminology, and healthcare billing procedures. The successful candidate will be a team player who is dependable, organized, enthusiastic, and detail oriented. Important to this position is the ability to build relationships with our customers, both internal and external, to promote feedback and timely resolution of outstanding claims. Proficiency in many computer software programs is required as well as an understanding of insurance payment methodologies to insure accurate reimbursement. A positive "can-do" attitude is a must.

Responsibilities

• Following policies and procedures, timely and accurate follow up on claims for the resolution of outstanding balances.
• Participates in the collection and documentation of claims processing rules.
• Generates both electronic and hard copy claims for submission.
• Obtains supporting documentation and other information required to insure acceptance of claim.
• Interacts and communicates effectively with interdepartmental units when necessary.
• Documents account information pertaining to claims submission and resolution.
• Enters demographic data into the billing & collections software.
• Assumes other duties and responsibilities as needed.