Accounts Data Denials Specialist

About the job
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

Accounts Data Denials Specialist