Denial Management Specialist

Job DetailsJob Location: Corporate HQ - QUINCY, MA 02171Salary Range: $60,000.00 - $65,000.00 Salary/yearOur mission. Northeast Recovery is a network of Drug and Alcohol Addiction Treatment Facilities that provide a variety of levels of care to those who are prepared to begin their journey toward recovery. We are looking for a full time remote Denial Management Specialist at NER! Schedule: Full Time Salary: $60,000 – $65,000 annually (depending on experience and qualifications) Position Summary The Denial Management Specialist is responsible for the identification, investigation, appeal, and resolution of insurance claim denials for inpatient and outpatient behavioral health services. This role serves as a key member of the Revenue Cycle Management team, working to maximize reimbursement, reduce avoidable denials, and improve overall financial performance. The Denial Management Specialist will analyze denial trends, coordinate with internal departments, and communicate with insurance payers to ensure claims are processed accurately and timely. The ideal candidate possesses strong analytical skills, extensive knowledge of insurance reimbursement processes, and experience working with behavioral health claims. Essential Duties and Responsibilities Review, analyze, and prioritize denied claims from commercial insurance carriers, Medicaid, Medicare, and managed care organizations. Investigate denial reasons and determine appropriate corrective actions. Prepare and submit first-level and second-level appeals, reconsiderations, and supporting documentation. Work directly with insurance representatives to resolve denied or underpaid claims. Monitor denial work queues and aging reports to ensure timely follow-up and resolution. Research payer policies, coverage guidelines, and contractual requirements. Identify root causes of denials and collaborate with internal departments to implement corrective actions. Track and report denial trends, appeal outcomes, and reimbursement opportunities. Escalate complex denial issues to management when appropriate. Maintain accurate and detailed documentation of all denial-related activities within the billing system. Collaborate with admissions, utilization review, billing, coding, clinical, and authorization teams to resolve reimbursement barriers. Assist in developing and maintaining denial prevention strategies. Meet established productivity, quality, and recovery performance goals. Maintain compliance with all federal, state, payer, and company regulations. Remote Work Responsibilities Effectively manage denial inventory and productivity while working remotely. Participate in virtual team meetings and training sessions. Maintain regular communication with management and internal departments. Adhere to all HIPAA, privacy, cybersecurity, and remote access requirements. Maintain a professional and secure home office environment.

Qualifications

Education High School Diploma or GED required. Associate's degree in Healthcare Administration, Business, Finance, or related field preferred. Experience Minimum of two (2) years of healthcare denial management, accounts receivable, medical billing, or insurance follow-up experience required. Behavioral health, mental health, substance abuse treatment, inpatient, or outpatient reimbursement experience preferred. Experience working with commercial insurance, Medicaid, Medicare, and managed care organizations required. Experience preparing and managing insurance appeals preferred. Why Work for Us! We provide an environment where our employees can grow and advance professionally, with a healthy balance between work and personal lives. Our biggest investment is in our employees, so we reward and recognize hard work by promoting from within when possible. We pay competitively and offer a variety of benefits to meet your wellness and financial needs. EEO and Accommodations We are deeply committed to building a workplace and community where inclusion is not only valued but prioritized. We are proud to be an equal opportunity employer, seeking to create a welcoming and diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, family status, marital status, sexual orientation, national origin, genetics, neurodiversity, disability, age, or veteran status, or any other non-merit based or legally protected grounds. We are committed to providing reasonable accommodations to qualified individuals with disabilities in the employment application process. To request accommodations, please contact Human Resources at least one week in advance of your interview.

Qualifications

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