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Authorization and Denials Specialist (Medical Biller)
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Confidential
Braintree, MA (In Person)
$59,280 Salary, Full-Time
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Job Description
Authorization and Denials Specialist (Medical Biller) Confidential Braintree, MA Job Details Full-time $25 - $32 an hour 1 day ago Qualifications Attention to detail Patient interaction Health information management Managing patient records Medical terminology Documentation review Full Job Description Job Overview We are seeking a highly motivated and detail-oriented Authorization and Denials Specialist to join our dynamic medical billing team. In this vital role, you will be responsible for managing prior authorization requests, reviewing claim denials, and ensuring timely resolution of billing issues. Your expertise will help optimize revenue cycles, improve patient satisfaction, and ensure compliance with healthcare regulations. If you thrive in a fast-paced environment and possess a passion for accuracy and problem-solving, this opportunity is perfect for you! Responsibilities Review and process prior authorization requests for various medical procedures and services, ensuring all necessary documentation is complete and accurate. Analyze claim denials related to authorization issues, coding discrepancies, or documentation deficiencies, and develop strategies to resolve them efficiently. Collaborate with healthcare providers, insurance companies, and patients to gather additional information or clarification needed for authorization approvals or appeals. Utilize Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems to document all actions taken and maintain detailed records of authorization statuses and denial resolutions. Apply knowledge of medical coding including CPT (Current Procedural Terminology), ICD-9, ICD-10 codes, DRG (Diagnosis-Related Group), and other relevant coding standards to support accurate billing processes. Monitor outstanding authorizations and follow up regularly to prevent delays in patient care or revenue collection. Stay informed about evolving insurance policies, healthcare regulations, and coding updates to ensure compliance and optimize reimbursement outcomes. Experience Proven experience in medical billing or coding with a focus on authorizations and denials management. Strong understanding of medical terminology, medical records management, and insurance claim processes. Familiarity with DRG classifications, CPT coding, ICD coding (ICD-9/ICD-10), and medical collection procedures. Hands-on experience working with EMR systems and EHR platforms for documentation and workflow management. Excellent communication skills to effectively liaise with healthcare providers, insurance representatives, and patients. Ability to analyze complex claims data quickly and accurately identify issues impacting reimbursement or approval status. #RJAF123