Denials Recovery Specialist

Description

Job Overview
We are seeking a detail-oriented and knowledgeable Specialist to join our team. The ideal candidate will possess a strong understanding of medical coding, billing, and terminology. This role is essential in ensuring accurate documentation and compliance within our medical office environment.

About the Organization
We are a fast-growing medical billing organization in the Lake Success area, dedicated to delivering exceptional results for our provider partners. We're seeking revenue cycle professionals at all levels - whether your expertise is in insurance follow-up, denials recovery, or the broader revenue cycle - who thrive on solving problems and getting claims paid.

The Opportunity
Join our collaborative team handling surgical and out-of-network claims, appeals, denials, and overall reimbursement recovery. This role is for professionals who don't just post charges, but who investigate, analyze, and strategize to ensure maximum payment.

Key Responsibilities

• Analyze EOBs for out-of-network and surgical claims to identify underpayments or denials
• Research payer portals and policies to support appeals
• Use past payment history, CPT code research, and carrier guidelines to build cases for reimbursement
• Initiate insurance calls as needed to confirm claim status or policy details
• Track and follow up on appeals to successful resolution
• Utilize Excel for reporting and analysis

What We're Looking For

• At least 3 years of out of network experience within revenue cycle performing insurance follow-up calls investigating medical claims
• Submitting appeals
• Researching denied claims
• Experience processing surgical claims preferred
• Background processing commercial insurance
• Strong portal and system navigation skills, with the ability to quickly adapt to new technology
• Analytical mindset - able to think through a claim from start to finish and decide the next step
• Proactive problem-solver with initiative to investigate without waiting for direction

Schedule

• Monday to Friday, 37.5-hour work week
• Choice of shifts: 8:30 a.m. - 5:00 p.m. or 9:00 a.m. - 5:30 p.m.
• Half-hour lunch break

We are an equal opportunity employer and comply with all applicable federal, state, and local fair employment practices laws. We strictly prohibit and do not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex, sexual orientation, gender (including gender identity and expression), marital or familial status, age, physical or mental disability, perceived disability, citizenship status, service in the uniformed services, genetic information, height, weight, or any other characteristic protected under applicable federal, state, or local law. Applications from members of minority groups and women are encouraged.