Denial Resolution Specialist

Job Summary

The Direct Carrier Denial Resolution Specialist is an integral part of the Carrier-to-Carrier team. The right candidate will be in constant communication with a variety of insurance companies for payment resolution. They must communicate persuasively, with a clear understanding of denial codes and reasons and help formulate responses to those denials. The Denial Resolution Specialist will also assist in other administrative duties including working in other payer systems to do claim follow up.

Hours: Day shift, 40-hour work weeks. During training, 8am - 5pm. Flexible schedule options available after training is completed.

Setting: Professional office environment with remote opportunity after training is completed.

Compensation: This is a non-exempt position at a very competitive hourly rate. Our comprehensive benefit package includes health and dental benefits, short-term disability plans, 401k with company matching, paid time off policy and more. We also offer an onsite gym, cafe, and coffee shop.

Training: The Rawlings Company takes great pride in providing exemplary training and development program, including policies and procedures, state-of-the-art proprietary systems, and many other tools to place new employees on the path to success.

Responsibilities

• Phone contact with insurance carriers for the resolution and explanation of insurance denials.
• Comprehensive understanding of insurance EOBs
• Reviewing claims, Reporting Denial trends, Keeping detailed records of communications with Insurance Companies.
• Coordinating with providers to inquire about medical records and documentation needed for claim processing.
• Knowledge of filing and tracking medical insurance appeals
• Maintaining and adhering to the responsibility for client access, for the retrieval of claim forms that our billing specialist need.
• Maintains and records all communication with insurance companies and keeps a follow schedule.
• Must have excellent follow up and follow through skills.

Qualifications

• Bachelor’s Degree preferred or equivalent combination of education and experience in the health insurance, related fields, which would provide the necessary knowledge, skills, and abilities to successfully perform the work.   Experience.
• At least two years of experience as a Denial Resolution Specialist/Recovery Specialist
• Communication experience with insurance companies.
• Good oral and written communication skills, including excellent phone communication skills.
• Strong organizational and administrative skills
• Ability to work well in a team environment.
• Ability to multi-task and work independently as required. 
• Excellent time management and analytical skills required. 
• Always displays professional behavior in dealings with clients, members, peers, trainees, Audit management and any other individual with whom this position interacts.  This applies equally to personal, written or telephone contact.

Physical Requirements

• Frequently remains in sitting position for long periods of time to perform duties.
• Frequently concentrates for long periods of time, paying close attention to detail.
• Frequently uses and views the computer using fingers, hands, and vision.
• Frequently works in a well-lit, tempered environment.
• Occasionally moves through office to communicate with other employees  

Our Company Culture

The Rawlings Group is looking for hard-working, talented people who share our commitment to excellence to join our company. The Rawlings Company has successfully provided cost containment services to the largest health insurers in the country for more than 40 years and continues to grow as an industry leader.

Our Culture is focused on:

• The guiding principle of doing the right thing
• Caring for our employees and taking pride in the work they do
• Providing recognition and financially rewarding employees for their success

Our Values are:

• Integrity and Trust
• Customer Service Excellence
• Innovation
• Diversity and Inclusion
• Honoring our Veterans and Their Service 

*Equal Employment Opportunity.  It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification.
*The Rawlings Group is an employment at will employer.

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