Hospital Denial Claims Specialist Job at Robert Half (Dallas)

Claims Resolution Specialist I, Hospital Billing Office

Baptist Health is hiring a Claims Resolution Specialist I for our Hospital Billi...

Location

United States , Jacksonville

Salary:

Not provided

Baptist Health (Florida)

Expiration Date

Until further notice

Requirements

Accounts Receivable Experience Required
Billing Experience Required
Knowledge of CPT, ICD10, HCPCS, and Modifiers Required
Medical Insurance Experience Required
Reimbursement Experience Required
1-2 years of Revenue Cycle Operations Experience Required
High school diploma (or higher) Required

Job Responsibility

Resolves each medical claim sent to commercial insurance companies, third party organizations and/or government payers
Analyzes explanation of benefits to insure proper payment to Baptist Health from paying entities
Communicates with third-party representatives as necessary to complete claims processing and /or resolve problem claims
Follows-up daily on post processing activity including but not limited to, rejected billings, adjustments, corrected claims, overpayments, and denied claims
Works all assigned accounts on worklist in order depending on balance and age
Identify and communicate trends in denials to leadership
Requires experience in either HB or PB while working toward competency in all areas of the assigned vertical
Communicates with various departments to resolve any outstanding issues with claim to resolve denials
Possesses up to date knowledge related to CPT codes, ICD/10 codes

Fulltime

Hospital Medical Collections Specialist

A respected hospital in the San Fernando Valley is seeking an experienced and re...

Location

United States , North Hollywood

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of hospital medical collections or healthcare revenue cycle experience required
Strong understanding of hospital billing, insurance follow-up, and denial management processes
Experience working with government and commercial payers, including Medicare and Medi-Cal managed care plans
Knowledge of inpatient and outpatient claim processing preferred
Excellent analytical, problem-solving, and communication skills
Ability to work independently in a fast-paced healthcare environment while managing multiple priorities
Proficiency in healthcare billing systems and Microsoft Office applications

Job Responsibility

Perform comprehensive follow-up on outstanding hospital accounts to secure accurate and timely reimbursement from insurance carriers and third-party payers
Review inpatient and outpatient claims to identify billing issues, denials, payment delays, and underpayments, and take proactive steps toward resolution
Manage collection efforts across multiple payer types, including Medicare Managed Care, Medi-Cal Managed Care, commercial insurance plans, HMOs, and PPOs
Prepare and submit appeals, reconsiderations, and supporting documentation for denied or improperly processed claims
Research and resolve account discrepancies by reviewing billing records, remittance advice, payer correspondence, and claim history
Collaborate with billing, coding, admissions, and clinical departments to correct claim issues and improve reimbursement outcomes
Maintain accurate and detailed documentation of collection activity, payer communications, and account status updates
Monitor assigned accounts to reduce aging AR and improve overall collection performance
Support departmental goals related to cash collections, denial management, and revenue cycle efficiency

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan
Free online training

Fulltime

Hospital Medical Collections Specialist

A Hospital in the San Fernando Valley are looking for an experienced Hospital Me...

Location

United States , Van Nuys

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 3 years of recent experience in hospital billing and medical collections
Hands-on knowledge of hospital revenue cycle processes, including claim follow-up, denial resolution, and appeals management
Experience working with multiple payer categories such as Medicare managed care, Medi-Cal managed care, and commercial insurance plans
Familiarity with HMO and PPO reimbursement structures in a hospital setting
Understanding of both inpatient and outpatient hospital accounts
Strong analytical skills with the ability to review account activity and identify barriers to payment
Effective communication and organizational skills to manage a high volume of accounts and payer interactions

Job Responsibility

Pursue payment on outstanding hospital accounts by conducting thorough follow-up with insurance carriers and other payers to secure accurate and timely reimbursement
Review inpatient and outpatient claims to identify billing issues, payment delays, denials, and underpayments, then take appropriate action to move accounts toward resolution
Manage collection activity across a range of payer types, including Medicare managed care, Medi-Cal managed care, commercial plans, and HMO or PPO coverage
Prepare and submit appeals, reconsiderations, and supporting documentation to challenge denied or incorrectly processed claims
Investigate account discrepancies by analyzing billing records, payer responses, and remittance details to determine the next steps for resolution
Coordinate with internal teams to correct claim information, resolve documentation gaps, and improve the collection of hospital receivables
Maintain detailed account notes and status updates to ensure clear documentation of collection efforts and payer communications

What we offer

Medical
Vision
Dental
Life and disability insurance
401(k) plan

Fulltime

Hospital Medical Collections Specialist

A respected hospital in the San Fernando Valley is seeking an experienced and re...

Location

United States , North Hollywood

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of hospital medical collections or healthcare revenue cycle experience required
Strong understanding of hospital billing, insurance follow-up, and denial management processes
Experience working with government and commercial payers, including Medicare and Medi-Cal managed care plans
Knowledge of inpatient and outpatient claim processing preferred
Excellent analytical, problem-solving, and communication skills
Ability to work independently in a fast-paced healthcare environment while managing multiple priorities
Proficiency in healthcare billing systems and Microsoft Office applications
All applicants applying for U.S. job openings must be legally authorized to work in the United States

Job Responsibility

Perform comprehensive follow-up on outstanding hospital accounts to secure accurate and timely reimbursement from insurance carriers and third-party payers
Review inpatient and outpatient claims to identify billing issues, denials, payment delays, and underpayments, and take proactive steps toward resolution
Manage collection efforts across multiple payer types, including Medicare Managed Care, Medi-Cal Managed Care, commercial insurance plans, HMOs, and PPOs
Prepare and submit appeals, reconsiderations, and supporting documentation for denied or improperly processed claims
Research and resolve account discrepancies by reviewing billing records, remittance advice, payer correspondence, and claim history
Collaborate with billing, coding, admissions, and clinical departments to correct claim issues and improve reimbursement outcomes
Maintain accurate and detailed documentation of collection activity, payer communications, and account status updates
Monitor assigned accounts to reduce aging AR and improve overall collection performance
Support departmental goals related to cash collections, denial management, and revenue cycle efficiency

What we offer

Medical, vision, dental, and life and disability insurance
401(k) plan

Fulltime

Hospital Medical Collections Specialist

A Hospital in the San Fernando Valley are looking for an experienced Hospital Me...

Location

United States of America , Van Nuys

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 3 years of recent experience in hospital billing and medical collections
Hands-on knowledge of hospital revenue cycle processes, including claim follow-up, denial resolution, and appeals management
Experience working with multiple payer categories such as Medicare managed care, Medi-Cal managed care, and commercial insurance plans
Familiarity with HMO and PPO reimbursement structures in a hospital setting
Understanding of both inpatient and outpatient hospital accounts
Strong analytical skills with the ability to review account activity and identify barriers to payment
Effective communication and organizational skills to manage a high volume of accounts and payer interactions

Job Responsibility

Pursue payment on outstanding hospital accounts by conducting thorough follow-up with insurance carriers and other payers to secure accurate and timely reimbursement
Review inpatient and outpatient claims to identify billing issues, payment delays, denials, and underpayments, then take appropriate action to move accounts toward resolution
Manage collection activity across a range of payer types, including Medicare managed care, Medi-Cal managed care, commercial plans, and HMO or PPO coverage
Prepare and submit appeals, reconsiderations, and supporting documentation to challenge denied or incorrectly processed claims
Investigate account discrepancies by analyzing billing records, payer responses, and remittance details to determine the next steps for resolution
Coordinate with internal teams to correct claim information, resolve documentation gaps, and improve the collection of hospital receivables
Maintain detailed account notes and status updates to ensure clear documentation of collection efforts and payer communications

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan
Free online training

Fulltime

Hospital Coding Quality Specialist - Inpatient

Location

United States

Salary:

28.55 - 42.85 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA)
Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA)
Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA)
Associate's Degree in Health Information Management or related field
Typically requires 5 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding quality review functions
Demonstrated leadership skills and abilities
Demonstrates knowledge of National Council on Compensation Insurance, Inc. (NCCI) edits, and local and national coverage decisions
Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS-DRGs (Diagnosis related groups)
Advanced knowledge in Microsoft Applications, including but not limited to
Excel, Word, PowerPoint, Teams

Job Responsibility

Reviews coded health information records to evaluate the quality of staff coding and abstracting, verifying accuracy and appropriateness of assigned diagnostic and procedure codes, as well as other abstracted data, such as discharge disposition
Ensure accurate coding for outpatient, day surgery and inpatient records
Verifies all codes and sequencing for claims according to American Hospital Association (AHA) coding guidelines, CPT Assistant, AHA Coding Clinic and national and local coverage decisions
Works collaboratively with coding leadership per their direction in reviewing records with focused diagnosis and procedure codes, including specific APCs, DRGs and OIG work plan targets to assure compliance in all areas of coding, which may give visibility into documentation that is driving codes
Works collaboratively with coding leadership to identify focused prospective records that need to be reviewed
Identifies coder education opportunities, team trends, and consideration of topics to mandate for second level account review, before the account is final coded
Reviews encounters flagged for second level review, including but not limited to
hospital acquired conditions (HACs), complications and other identified records such as core measures or trends as identified by coding leadership
Perform review of coded encounter for appropriate risk-adjustment, including accurate severity and risk of mortality assignment
Responsible for coding participation in the Clinical Documentation Improvement and Hospital Coding alignment process

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Fulltime

Medical Billing Specialist

Location

United States , Worcester

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience in medical billing within a healthcare, hospital, or social assistance setting
Working knowledge of medical coding principles and claim submission processes
Proven ability to handle accounts receivable follow-up, collections, and denial resolution
Familiarity with medical claims review, correction, and appeals procedures
Hands-on experience using EPACES or similar payer and billing systems
Strong attention to detail with the ability to manage multiple priorities accurately
Effective written and verbal communication skills for interacting with payers and internal teams

Job Responsibility

Manage billing activity for medical claims, ensuring charges are processed accurately and submitted within required timelines
Monitor accounts receivable balances and follow up on unpaid or underpaid claims to support prompt reimbursement
Investigate denied claims, determine root causes, and prepare corrected submissions or formal appeals as needed
Perform collection efforts on outstanding balances while maintaining clear communication with payers and relevant parties
Review coding and claim details for completeness and accuracy before resubmission or escalation
Use EPACES and related billing tools to verify claim status, eligibility, and payment information
Assist with reporting, documentation, and special projects related to billing operations and revenue cycle performance

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan

Fulltime

Medical Biller/Collections Specialist

We are looking for a detail-oriented Medical Biller/Collections Specialist to su...

Location

United States , Philadelphia

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience in medical billing, medical collections, denials, appeals, or hospital billing is preferred
Proficiency with Microsoft Excel and Word, including the ability to manage spreadsheets and organize documentation
Strong data entry skills with close attention to accuracy and completeness
Ability to balance multiple tasks effectively and adapt to shifting priorities throughout the day
Excellent organizational skills and the ability to handle administrative responsibilities in a structured manner
Experience working in a healthcare environment is an advantage
Familiarity with Navinet or similar healthcare payer tools is a plus

Job Responsibility

Provide day-to-day administrative assistance to the billing and reimbursement team to help keep departmental workflows running smoothly
Prepare, scan, print, and review billing documents to ensure information is complete, accurate, and ready for processing
Build, maintain, and update Excel spreadsheets and other tracking tools used for departmental reporting and recordkeeping
Sort incoming mail, distribute correspondence to the appropriate team members, and coordinate outgoing billing-related mailings
Investigate returned mail, verify patient or account details, and update internal records to reflect corrected information
Send patient statements and secondary claim documentation in a timely manner while supporting follow-up on outstanding items
Enter billing and account information into the system with a high level of accuracy and attention to detail
Assist with collection activities, denial follow-up, appeals support, and other related assignments as directed by leadership

What we offer

medical
vision
dental
life and disability insurance
company 401(k) plan

Select Country

Hospital Denial Claims Specialist

Job Description

Job Responsibility

Requirements

What we offer

Looking for more opportunities?