Appeals and Denials Specialist Position Available In Palm Beach, Florida

Appeals and Denials Specialist

NRG MGMT LLC

Lake Worth, FL Job Details Full-time Estimated:

$38.9K – $45.8K a year 9 hours ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance 401(k) matching Professional development assistance Life insurance Qualifications Microsoft PowerPoint Microsoft Word Some college Microsoft Excel Addiction counseling Inpatient HIPAA Mid-level Microsoft Office Analysis skills Communication skills Full Job Description The Appeals and Denials Specialist will be responsible for managing and resolving claim denials and appeals efficiently and effectively. This role requires a deep understanding of industry regulations, strong analytical skills, and the ability to communicate clearly and professionally with payers. Review denied or underpaid medical claims for accuracy and compliance with payer guidelines Draft and submit written appeals to insurance companies or other payers, citing supporting medical documentation, coding references, and policy guidelines Monitor the status of submitted appeals and follow up to ensure timely resolution Analyze explanation of benefits (EOB’s) and remittance advice (RAs) to identify denial trends or coding issues Collaborate with billing teams to correct errors and resubmit claims as needed Maintain detailed records of appeal activities and outcomes in the patient account management system Act as liaison between healthcare providers, patients, and insurance companies to resolve payment disputes Communicate effectively with physicians and other healthcare professionals to obtain additional documentation or clarification needed for appeals Participate in team meetings and share insights on payer-specific denial trends or policy changes Stay updated on changes in medical billing codes, payer policies, and reimbursement guidelines Escalates payer denials trends or claims issues to the PFS Leadership Team to address with the payer Identifies trends, system issues, and potential process improvements to avoid future delays and denials Fosters an inclusive and engaged environment through teamwork and collaboration Safety And Performance Improvement Demonstrates accountability and commitment to quality work Participates actively in process improvement and adoption of standard work Stewardship Demonstrates responsible use of LRH’s resources, including people, finances, equipment, and facilities Knows and adheres to organizational and department policies and procedures Demonstrates accountability and commitment to quality work Participates actively in process improvement and adoption of standard work Actively participates in team development, achieving dashboards, and in accomplishing department goals and objectives Responsible for all aspects of follow-up and collections on accounts This includes making outbound calls to payers and accessing payer websites Research denials and works with other departments such as Collections, Billing and UR Submits the insurance reconsideration/appeals with supporting documentation promptly and follows up with insurance to ensure receipt and processing Follows insurance payer claims and appeals’ timely filing guidelines Responsible for working correspondence timely and efficient manner (including EOBs, RA’s, denial letters) Knowledge of HIPAA guidelines

Experience :

A minimum of 1 to 2 years’ experience in appeals and denials, preferably in a healthcare setting. Previous appeals and denials experience preferred. Substance Abuse experience preferred

Education :

Preferred some college or related vocational training.

Benefits :

401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Professional development assistance Tuition reimbursement Vision insurance

Schedule:

8-hour shift Monday to Friday Ability to commute/relocate:

Boca Raton, FL:

Reliably commute or planning to relocate before starting work (Required)

Work Location:

In person

WORK ENVIROMENT & PHYSICAL REQUIREMENTS

Work is performed in an office setting. Prolonged periods sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at a time.

Physical demands of position:

sitting, standing, walking, typing, phone communication, face to face conversation.

Job Type:

Full-time Behavioral and mental health experience is preferred, but not limited to Inpatient, Outpatient, mental health, and substance abuse billing(at least 3 years) Ability to prioritize tasks properly Organized and able to multitask Excellent verbal and written communication skills Proficient in Microsoft Office Suite (Excel, Word, PowerPoint, Outlook)

Job Type:

Full-time Work Location:

In person