Description:
We are seeking a Claim Denial Specialist with deep knowledge of the US healthcare system and insurance processes—specifically for mental and behavioral health claims. In this role, you will be responsible for identifying, analyzing, and resolving denied insurance claims to ensure timely reimbursement and reduce revenue cycle delays.
Key Responsibilities
- Review Explanation of Benefits (EOBs) and denial codes for accuracy and appeal opportunities
- Contact insurance companies to understand denial reasons and clarify claim status
- Prepare and submit corrected claims and appeals with supporting documentation
- Collaborate with internal billing, eligibility, and provider teams to resolve recurring issues
- Track and follow up on outstanding appeals and reprocessed claims
- Maintain detailed records in the billing system and report denial trends or payer issues
Qualifications
- 2+ years of experience handling claim denials and appeals in a healthcare billing or revenue cycle role
- Strong understanding of mental health billing codes, parity laws, and payer requirements (e.g., CPT, ICD-10, modifiers)
- Familiarity with insurance portals (e.g., Availity, payer sites) and clearinghouses
- Knowledge of HIPAA, insurance EOBs, and denial management best practices
- Detail-oriented, organized, and capable of managing multiple priorities independently
- Strong communication and documentation skills