Denials Management Specialist
Panorama Eyecare
Date: 3 weeks ago
City: Fort Collins, Colorado
Salary:
$23.56
-
$26.8
per hour
Contract type: Full time
Remote
Description
Who We Are:
At Panorama Eyecare, we are not just a team; we are a community of dedicated professionals united in our quest to provide the best eyecare anywhere. Our unflinching commitment to excellence and our core values make us an Employer of Choice. Join us in shaping the future of eyecare as we thrive together!
The Position
The Denials Management Specialist plays a critical role in ensuring accurate and timely resolution of denied claims, identifying trends, and implementing effective appeals strategies to maximize revenue recovery. This role requires strong analytical skills, problem-solving expertise, and a deep understanding of medical billing processes, particularly in ophthalmology, optometry, retina, and cataracts. The ideal candidate is a highly skilled communicator who can collaborate across teams to drive results and prevent future denials.
Responsibilities
Performance/Skills Requirements:
Embark on a rewarding journey with Panorama Eyecare and become part of a team that embodies the values of Partnership, Engagement, Excellence, and Stewardship. As an Eyecare Professional, you will not only provide exceptional patient care but also shape the future of our practices. Together, we are transforming the eyecare landscape. Our job postings are open for 30 days or until a qualified candidate is hired. Click "apply" now and let your passion for excellence and patient well-being shine!
Eeoc
Panorama Eyecare is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any characteristic protected by law.
Who We Are:
At Panorama Eyecare, we are not just a team; we are a community of dedicated professionals united in our quest to provide the best eyecare anywhere. Our unflinching commitment to excellence and our core values make us an Employer of Choice. Join us in shaping the future of eyecare as we thrive together!
The Position
The Denials Management Specialist plays a critical role in ensuring accurate and timely resolution of denied claims, identifying trends, and implementing effective appeals strategies to maximize revenue recovery. This role requires strong analytical skills, problem-solving expertise, and a deep understanding of medical billing processes, particularly in ophthalmology, optometry, retina, and cataracts. The ideal candidate is a highly skilled communicator who can collaborate across teams to drive results and prevent future denials.
Responsibilities
- Analyze and manage claim denials to identify trends, root causes, and potential resolutions.
- Conduct thorough investigations of denied claims, including coding reviews and payer-specific policy research.
- Communicate with payers to appeal denied claims and ensure timely resolution.
- Manage the complete claims resolution process, including appeals and follow-up, to ensure proper reimbursement.
- Collaborate with billing staff, coding professionals, and clinical teams to provide feedback and implement denial prevention strategies.
- Maintain accurate documentation of denial management activities, including tracking outcomes and process improvements.
- Stay updated on payer policies, medical coding guidelines, and regulatory changes affecting claims processing.
- Provide regular reports and analysis of denial patterns to management, offering actionable recommendations.
Performance/Skills Requirements:
- Denial Resolution Expertise: Strong knowledge of claims adjudication, appeals, and reimbursement processes.
- Analytical Thinking: Ability to identify denial trends, root causes, and develop strategic solutions.
- Communication Excellence: Strong written and verbal communication skills for payer interactions and internal collaboration.
- Collaboration & Teamwork: Proven ability to work cross-functionally with billing, coding, and clinical teams to optimize revenue cycle performance.
- Attention to Detail: Ability to retain and apply complex information accurately and efficiently.
- Technical Proficiency: Experience using claims management and billing software to track and resolve denials.
- Minimum of 5 years of experience in medical claims denials management, including resolution and appeals processes.
- Familiarity with CPT, ICD-10, and HCPCS coding; certification (CPC, CCS-P) is a plus.
- Experience in eye care specialties (ophthalmology, optometry, retina, cataracts) and ASC operations is highly desirable.
- Familiarity with the electronic health record (EHR) NextGen and payer portals.
- Strong organizational skills with the ability to prioritize and manage multiple tasks efficiently.
- This is a Full-Time remote position for candidates who reside in one of the following approved states: CO, FL, KS, MA, MI, MO, NM, OR, PA, SC, VA, WY, TX, NC.
- Compensation for this role will be $23.56 – $26.80 based on experience and qualifications.
- PTO Accruals Start at 3 Weeks
- Comprehensive Medical and Dental Insurance
- Company-Paid Optical Allowance
- Company-Paid Routine Eye Care
- Short-Term and Long-Term Disability Insurances
- Educational Allowance
- Paid Holiday Program
- 401K with Company Match
Embark on a rewarding journey with Panorama Eyecare and become part of a team that embodies the values of Partnership, Engagement, Excellence, and Stewardship. As an Eyecare Professional, you will not only provide exceptional patient care but also shape the future of our practices. Together, we are transforming the eyecare landscape. Our job postings are open for 30 days or until a qualified candidate is hired. Click "apply" now and let your passion for excellence and patient well-being shine!
Eeoc
Panorama Eyecare is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any characteristic protected by law.
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