Revenue Cycle Clinical Denials Specialist

Pride Health is hiring a Revenue Cycle Clinical Denials Specialist to support our client's healthcare facility in Fort Worth, TX. Interested? Apply Today! 
 
Job Details: 
Schedule:  Monday–Friday, 9 am- 5 pm
Location: Fort Worth, TX 76116 (Onsite)
Job Type: Local contract
Contract Length: 13 weeks of Contract with possible extension.
Pay Range: $31- $33 per Hour on W2
*Pay offered is based on experience, expertise, credentialing, and education.  
 
Duties: 

• Review and analyze clinical denials, accounts, charges, and medical documentation.
• Manage denials related to authorization, referrals, late notifications, level of care, medical necessity, and other payer issues.
• Prepare and submit professional appeals and reconsiderations based on clinical documentation, payer policies, contracts, and regulations.
• Track denial activity, outcomes, and trends; identify recurring issues and recommend process improvements.
• Communicate denial trends and reimbursement issues to Revenue Cycle leadership and stakeholders.
• Support audits, compliance activities, and process documentation.
• Maintain accurate denial and appeal records while meeting payer submission deadlines.

Requirements: 

• Education: High school diploma or equivalent.
• License(s): NA
• Certification(s): NA 
• Years of experience:

• Prior Epic Systems Revenue Cycle Solutions (HB Resolute) experience required.

• Skills/Specialties/Technology:

• Strong knowledge of hospital billing, CPT, HCPCS, ICD-10, insurance terminology, and payer policies.
• Knowledge of healthcare reimbursement methodologies, payer contracts, and billing/coding regulations.
• Experience with clinical denial appeals and medical necessity review.
• Working knowledge of InterQual and/or Milliman Care Guidelines (MCG).
• Excellent written and verbal communication, analytical, problem-solving, and organizational skills.
• Ability to work independently in a fast-paced, constantly changing environment.

#PHCNonClinicalZipFor workers in the United States, PrideGlobal and it's affiliates offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, pet insurance and employee discounts with preferred vendors.

Equal Employment Opportunity
PrideGlobal and it's affiliates are an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment
PrideGlobal and it's affiliates are a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations
We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.

Only applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.