Billing Denials Management Specialist

Billing Denials Management Specialist


Location: Remote
Department: Billing
Reports To: Denial Billing Team Lad
Salary: 35,000 - 40,000 php

About Us:

RML-PH is a dynamic and innovative Health Solutions and Care Delivery Organization committed to transforming the healthcare landscape. With a mission to provide accessible, high-quality healthcare services and cutting-edge solutions, RML-PH focuses on holistic patient care and embraces the latest advancements in health technology. Our team is dedicated to providing top-tier customer care, leveraging expertise and technology to exceed expectations. Join us at RML-PH to be part of a dynamic team committed to delivering excellence in healthcare customer service.

Position Summary:

The Billing Denials Management Specialist plays a critical role in the revenue cycle by investigating, resolving, and preventing insurance claim denials. This position is responsible for analyzing rejected claims to identify root causes, developing and implementing corrective action plans, and creating sustainable processes to reduce future denials. The specialist will work closely with the billing team, coders, and payers to ensure that claims are processed accurately and efficiently, maximizing reimbursement and maintaining financial health.

Key Responsibilities:

• Investigate and resolve all assigned insurance claim denials in a timely and efficient manner.
• Analyze denial trends to identify root causes and patterns by payer, provider, or service type.
• Develop, document, and implement standard operating procedures for resolving common denial reasons.
• Prepare and submit compelling appeals to insurance companies with all necessary documentation.
• Collaborate with the coding team and clinical staff to obtain corrected information or documentation for claim resubmission.
• Track and report on denial statuses, recovery rates, and the financial impact of denial trends.
• Maintain up-to-date knowledge of payer policies, billing regulations, and industry standards related to medical billing and denials.
• Perform other duties as assigned related to revenue cycle management.

• In-depth knowledge of the entire medical billing and revenue cycle process, from claim submission to payment posting.
• Strong understanding of CPT, ICD-10, and HCPCS coding systems, as well as medical terminology.
• Expertise in interpreting Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs).
• Excellent analytical and problem-solving skills to identify the root cause of complex denials.
• Ability to develop and document clear, concise processes and workflows.
• Exceptional written and verbal communication skills for crafting effective appeals and communicating with payers.
• Proficient in using billing software and EMR systems (e.g., AdvancedMD or similar).
• Strong organizational skills and the ability to manage multiple priorities and meet deadlines.
• Knowledgeable on current U.S. laws and regulations related to medical billing, including federal and state- specific guidelines.

Qualifications:

• Minimum of 3 years of experience in a medical billing role with a focus on denials management, appeals, and collections.
• High school diploma or equivalent required; Associate's degree or relevant certification is a plus.
• Proven track record of successfully appealing and recovering denied claims.
• Experience in a laboratory or similar outpatient setting is highly preferred.
• Familiarity with HIPAA regulations, the False Claims Act, and other healthcare compliance standards.

Benefits:

• Paid leave: Sick, Annual, Public holidays. 
• New Hires begin as independent contractors for the first 6 months before they are eligible for a review for full-time employment.