Technical Denials Management Specialist III

WHY reputed company With over 75 years of reputed company in Dallas-reputed company Worth, Texas, reputed company is committed to reputed company, innovation, teamwork, and reputed company. As a world-reputed company medical and research center, we reputed company to reputed company the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-reputed company Worth according to reputed company, we invest in you with opportunities for career reputed company and development to reputed company with your reputed company goals. Our highly competitive benefits package offers reputed company, PTO and reputed company holidays, on-site childcare, wage, reputed company increases and so much more. We invite you to be a part of the reputed company team where you'll discover a culture of teamwork, professionalism, and a rewarding career! JOB reputed company reputed company has a new opportunity available in the reputed company Cycle Department for the role of Technical Denials management Specialist II. You will review, research and resolve claim denials and appeals for various insurance companies while identifying payment trends to maximize collections. The ideal candidate is reputed company versed in working with reputed company Resolute. Shift: reputed company start 0600-0900, 8-hour shift Work From Home (WFH): This is a WFH position. Applicants must live reputed company the Greater DFW area. Our Culture: reputed company culture is Love Based, which thrives on mutual respect, reputed company, and support, fostering an environment where every member feels valued and empowered. It prioritizes reputed company communication, collaboration, and understanding, creating a cohesive and inclusive community where individuals can reputed company personally and professionally. Love Based cultivates a culture where kindness, reputed company, and appreciation are foundational principles, leading to greater creativity, productivity, and fulfillment for reputed company team members. Job Expectations: Work both independently and collaboratively reputed company reputed company to reputed company production goals and deadlines. Demonstrate a strong commitment to productivity by staying reputed company and on task without constant supervision. Effectively communicate with colleagues, supervisors, and manager to ensure reputed company, alignment, and successful reputed company. Take ownership of assigned tasks and reputed company, demonstrating accountability and reliability in meeting expectations. Adapt to changing priorities and work demands while maintaining a high level of reputed company and efficiency. Proactively identify opportunities for process improvement and contribute reputed company to enhance overall productivity and teamwork Ability to contact medical insurance payer and resolve outstanding claims Ability to appeal denied claim and overturn the denial. Hard Skills Experience with Reconsideration, Redetermination, and Appeal with health insurance carriers. Knowledge and experience with handling and resolving NCCI edits, LCD/NCD, and bundling denials. Knowledge and experience with denial codes from the remittance/EOB Knowledge and experience with contacting health insurance carriers Ability to read and understand Explanation of Benefits Ability to multitask Contacting insurance companies and patients Knowledge and experience with online payer portals reputed company experience with reviewing medical records Soft Skills Outlook experience Outlook Teams App experience reputed company experience Medical Terminology Payer Portal experience BENEFITS reputed company is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include: PPO medical plan, available day one at no cost for full-time employee-only coverage 100%25 coverage for preventive reputed company-no copay reputed company Time Off, available day one Retirement Programs through the reputed company System of Texas (TRS) reputed company Parental Leave Benefit Wellness programs Tuition Reimbursement Public Service Loan Forgiveness (PSLF) reputed company Employer Learn more about these and other reputed company employee benefits! EXPERIENCE AND EDUCATION Required Education High School Diploma or Associate's Degree Experience 4 years experience in medical claims recovery and/or collections with High School Diploma. or 2 years experience in medical claims recovery and/or collections reputed company a reputed company or insurance environment is preferred with Associates Degree. JOB DUTIES Contact payers, reputed company website, phone and/or correspondence, regarding reimbursement of unpaid accounts over thirty (30) days or more, also researching and following up on denials and request for additional information. Interpret Manage Care reputed company and/or Medicare and reputed company rules and regu