Denials & Claims Resolution Specialist

Job Summary

Denials & Claims Resolution Specialist

resourceful, analytical, and action-oriented

Key Responsibilities

Utilize Laboratory Information System (LIS)

·       Analyze insurance payer denial reasons and take appropriate, timely actions such as claim correction, documentation submission, resubmission, or appeal.

·       Clarify denial causes and ensure resolution pathways are accurate and efficient.

·       Maintain a working knowledge of payer-specific rules, denial trends, rejection codes, and resolution timelines.

·       Correct and resubmit rejected or denied claims quickly and within company policy and guidelines.

·       Document claim status, payer communication, and resolution steps clearly and accurately in the billing and clearinghouse systems.

·       Identify and report recurring denial trends and system or process breakdowns to Revenue Cycle leadership for further action.

·       Collaborate with the internal teams to resolve registration or demographic errors impacting claims.

·       Participate in performance review meetings and denial trend analysis to ensure continuous improvement in denial prevention strategies.

·       Meet established KPIs for productivity, turnaround time, and quality assurance.

·       Ensure all actions are performed in full compliance with HIPAA and organizational policies.

·       Assist with other billing, reconciliation, or appeals tasks as assigned.

What You Bring

Required:

• College Graduate
• Experience in medical billing, focused on claim rejection and denial resolution for a diagnostic lab setting.
• Proficiency in Microsoft Office (Word, Excel, Outlook).
• Strong written and verbal communication skills.
• High attention to detail and strong organizational skills.
• Ability to work independently with a sense of urgency and accountability.
• Understanding of the end-to-end Revenue Cycle process.

Preferred Skills:

• Experience with patient registration workflows and systems.
• Workers' compensation billing or registration experience.
• Laboratory billing environment.
• Insurance payers.
• Identifying trends and contributing to denial prevention strategies