Denial Management Specialist
Location: Bakersfield, CA 93309
Schedule: Monday – Friday, 8:00 AM – 5:00 PM

We are seeking an experienced Denial Management Specialist to join a growing healthcare team. The ideal candidate will have at least 1 year of experience in medical claims and denial management and a strong understanding of medical billing and coding processes.

Position Summary:
The Denial Management Specialist ensures optimal performance in denial prevention and appeals processes. This role supports ongoing compliance with federal regulations and payer guidelines, while assisting with claim resubmissions to minimize reimbursement delays. This position also provides education and training to providers and staff as needed.

Essential Job Duties:
Follow up on denied claims from all commercial and contracted payers, resolving issues related to coding errors
Assign and sequence ICD-10-CM and CPT-4 diagnostic and procedural codes, reviewing clinical documentation for accuracy
Process claims in compliance with Medicare, AMA, and other applicable guidelines
Review and analyze medical records for appropriate ICD and CPT selection; serve as a coding subject matter expert
Investigate denied claims to ensure timely follow-up, coordinating with insurance representatives, providers, and billing specialists to execute action plans for claim resubmission
Conduct interim analysis of denials and provide feedback and education to stakeholders
Identify and escalate trends impacting denial volume
Monitor assigned self-pay accounts and update demographic information as necessary
Resolve routine coding issues and initiate provider training when needed

Requirements:
MUST HAVE a minimum 1 year of experience in medical claims and denial management
Strong knowledge of ICD-10-CM, CPT-4 coding, and healthcare billing practices
Experience with payer guidelines and appeals processes
Excellent communication and problem-solving skills
Ability to analyze data, identify trends, and recommend solutions

Preferred Qualifications:
Certification in Medical Coding (CPC, CCS, or equivalent) is a plus

EEO/AA Employer/Vet/Disabled.

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For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

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https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.