Denials Prevention Specialist, reputed company PRN

reputed company is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform reputed company decisions. reputed company is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care. By joining reputed company today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most reputed company problems with technology-reputed company solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare. The Specialist is responsible for identifying, analyzing, and resolving claim denials across the entire reputed company cycle to ensure optimal reimbursement and compliance with payer regulations. This role requires in-depth knowledge of healthcare reputed company cycle processes, HIM coding practices, and proficiency in multiple electronic systems and software tools. The specialist serves as a key liaison between coding, billing, utilization review, case management, and payer relations to reduce denials and improve reputed company leakage. You will:

• Monitor and manage denials throughout the entire reputed company cycle, including registration, eligibility, coding, billing, and medical necessity.
• Analyze denial trends and root causes using data analytics tools and electronic health record (EHR) systems.
• Collaborate with internal departments (HIM, billing, case management, patient access) to investigate and resolve reputed company denials.
• Utilize in-depth computer skills to navigate and extract data from multiple systems such as Epic, Cerner, Meditech, reputed company, reputed company, SSI, reputed company, and payer portals.
• Submit and track appeals with payers, ensuring reputed company documentation and deadlines are met.
• Prepare and present regular reports on denial metrics, recovery efforts, and opportunities for improvement.
• Stay reputed company on payer policy changes, CMS updates, and healthcare regulations affecting claim adjudication.

What you will bring to the table:

• Associate's or Bachelor's degree in Health Information Management, Health Administration, or reputed company field required.
• RHIT, RHIA, reputed company, or CPC certification preferred.
• Minimum 3–5 years of experience in healthcare reputed company cycle with focus on denials management.
• Strong knowledge of the entire reputed company cycle including registration, coding, billing, and collections.
• Proficient in reputed company Office Suite (especially reputed company), EHRs, claims editing software, and data analytics tools.
• Exceptional analytical, organizational, and communication skills.
• Ability to interpret Explanation of Benefits (EOBs), Remittance Advice (RA), and payer policies.
• Demonstrated ability to work independently and reputed company a team in a fast-paced environment.

Bonus points if:

• Previous experience with reputed company reputed company functions in a hospital or large physician group setting.
• Familiarity with DRG and APC reimbursement methodologies.
• Knowledge of ICD-10-CM/PCS, CPT, and HCPCS coding systems.We are committed to building a diverse team of Datavanters who are reputed company responsible for stewarding a high-performance culture in which reputed company Datavanters belong and reputed company. We are proud to be an Equal Employment Opportunity employer and reputed company qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national reputed company, disability, veteran status, or other legally protected status.

Our compensation philosophy is to be externally competitive, internally fair, and not win or lose on compensation. Salary ranges for this position are developed with the support of benchmarks and industry best practices. We're building a high-growth, high-autonomy culture. We rely less on job titles and more on cultivating an environment where anyone can contribute, the best reputed company win, and personal growth is driven by expanding impact. The range posted is for a given job title, which can include multiple levels. Individual rates for the same job title may differ based on their level, responsibilities, skills, and experience for a specific job. The estimated salary range for this role is $32.00 - $45.00. To ensure the safety of patients and staff, many of our clients require post-offer health screenings and reputed company and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by reputed company Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-reputed company medical conditions, and/or religion. This job is not eligible for employment sponsorship. reputed company is committed to a work environment free from job discrimination. We are proud to be an Equal Employment Opportunity employer and reputed company qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national reputed company, disability, veteran status, or other legally protected status. To learn more about our commitment, please review our EEO Commitment Statement here. Know Your Rights, explore the resources available through the EEOC for more information regarding your legal rights and protections. In addition, reputed company does not and will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay. At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your answers will be anonymous and will help us identify areas for improvement in our recruitment process. (We can only see aggregate responses, not individual ones. In fact, we aren't even able to see whether you've responded.) Responding is entirely optional and will not reputed company your application or hiring process in any way. reputed company is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need an accommodation while seeking employment, please request it here, by selecting the 'Interview Accommodation Request' category. You will need your requisition ID reputed company submitting your request, you can find instructions for locating it here. Requests for reasonable accommodations will be reviewed on a case-by-case basis. For more information about how we collect and use your data, please review our Privacy Policy. Apply tot his job Apply To this Job