Denials Specialist - Remote

JOB SUMMARY

Responsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues to NIC management, and generating appeals for denied or underpaid claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned.

Validate denial reasons and ensures coding in DCM is accurate and reflects the denial reasons. Coordinate with the Clinical Resource Center (CRC) for clinical consultations or account referrals when necessary,

Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations.