Accounts Data Denials Specialist

Somewhere; Johannesburg; Remote; ZAR 300,000 - 400,000; Full time

Job summary

A healthcare organization is seeking an Accounts Data Denials Specialist. This remote position involves analyzing denied claims, correcting data inconsistencies, and ensuring accurate documentation. Ideal candidates will have 1-2 years of experience in medical billing and a strong attention to detail. Join a mission-driven team focused on improving access to behavioral health services!

Benefits

Fully remote work environment

Professional growth opportunities

Supportive training and onboarding

Qualifications

• Experience in medical billing, insurance claims, or healthcare data management.
• Strong attention to detail and independent work ability.
• Excellent communication and problem-solving skills.

Responsibilities

• Analyze denied claims and make corrections based on AR team instructions.
• Update claim data and ensure document accuracy.
• Monitor denial trends and recommend process improvements.

Skills

Attention to detail

Data accuracy

Problem-solving

Communication

Education

1-2 years experience in medical billing

Familiarity with insurance denial codes

Proficient with electronic medical records (EMR)

Job description

Job Title: Accounts Data Denials Specialist

Schedule: Full-Time (40 hours/week), Monday-Friday EST

Location: Remote

Reports To: Accounts Receivable Manager

About The Role

We are seeking a detail-oriented and analytical Accounts Data Denials Specialist to support the Accounts Receivable (AR) team by reviewing denied insurance claims, correcting data inconsistencies, and ensuring accurate documentation. This role involves following directives from the AR team to investigate, clean up, and resubmit claims using attached medical records and other available data. Your work will directly support reimbursement efforts and improve revenue cycle efficiency.

Key Responsibilities

• Denial Review & Resolution
• Analyze denied claims to determine root causes such as coding errors, missing information, or documentation issues.
• Make appropriate corrections based on AR team instructions and prepare claims for resubmission.
• Communicate with insurance providers as needed to resolve outstanding issues.
• Data Cleanup & Documentation
• Update claim data and attach supporting medical records or documentation to facilitate clean resubmissions.
• Ensure data integrity and consistency across internal systems.
• Follow up on reprocessed claims to confirm resolution.
• Appeal Preparation
• Prepare appeal documentation when required, ensuring compliance with payer requirements.
• Coordinate with relevant teams to address coding or documentation deficiencies.
• Trend Analysis & Process Improvement
• Monitor and identify patterns in denial types and recommend workflow or process changes to reduce future denials.
• Collaborate with billing, coding, and compliance teams on preventive strategies.
• Cross-Team Communication
• Maintain timely communication with AR team, billing specialists, and other departments to ensure claim issues are resolved effectively.
• Assist with patient inquiries when necessary, providing accurate and empathetic support.
• Compliance & Reporting
• Stay current with payer guidelines, insurance regulations, and industry best practices.
• Generate reports related to denial trends, appeal outcomes, and claim status updates as requested.
  

Success Metrics

• Timely resolution of assigned denied claims
• Accuracy and completeness of data cleanup and documentation
• Reduced claim turnaround time and rejections upon resubmission
• Identification and documentation of denial trends
• High collaboration with AR and billing teams
  
  

Required Qualifications

• 1-2 years of experience in medical billing, insurance claims, or healthcare data management
• Familiarity with insurance denial codes, appeal processes, and EOBs
• Strong attention to detail and data accuracy
• Ability to follow detailed instructions and work independently
• Proficient with electronic medical records (EMR) and billing systems
• Excellent communication and problem-solving skills
  
  

Preferred Qualifications

• Experience working with ABA therapy or behavioral health billing
• Knowledge of HIPAA guidelines and insurance compliance
• Prior use of platforms like Silna, Availity, or similar tools
  
  

What We Offer

• Fully remote work environment
• Mission-driven team improving access to behavioral health services
• Professional growth opportunities within a fast-growing healthcare organization
• Supportive training and onboarding