Accounts Receivable and Denial Management Specialist (Remote Position) 3.3 3.3 out of 5 stars Clive, IA 50325 • Hybrid work About Us Iowa Digestive Disease Center and Iowa Endoscopy Center are proud to serve the community and surrounding area with regard to digestive health needs. Our endoscopy center is one of only three centers in Iowa recognized by the American Society for Gastrointestinal Endoscopy. The American Society for Gastrointestinal Endoscopy is known as the leader in setting standards for excellence in gastrointestinal endoscopy and has designed the only national program recognizing quality and safety in the practice of gastrointestinal endoscopy. Our center has also been accredited by the AAAHC, having met their rigorous quality and safety standards. AAAHC accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization's commitment to meeting certain performance standards.

Our board-certified physicians specialize in:

Gastroenterology, Hepatology, Diagnostic Endoscopy, Therapeutic Endoscopy, Infusion, and Advanced Therapeutics. Education Requirements Certified Professional Coder (CPC) is required High school graduate or equivalent is required Minimum of three (3) years' experience in a professional billing required LPN or RN licensure is preferred Job Summary The Clinical Denial Specialist plays a critical role in ensuring appropriate reimbursement for healthcare services by managing clinical claim denials. This advanced-level position involves comprehensive analysis of denied claims related to referrals, authorizations, medical necessity, non-covered services, and more. The specialist independently reviews medical records, payer policies, and account notes to determine the appropriate resolution—whether that be a revised claim, retro-authorization, appeal submission, or closure. Key responsibilities include crafting detailed, professional appeal letters grounded in clinical documentation, payer policy, and contract terms, submitting appeals timely, and tracking them through resolution. The role also involves identifying trends in denials, suggesting process improvements, and maintaining compliance with audit and regulatory requirements. Responsibilities Conduct thorough reviews of medical records, denial letters, and payer documentation Determine the root cause of denial (authorization, coverage, coding, medical necessity, etc.) Draft and submit comprehensive appeal letters using clinical rationale, payer policies, and supporting documentation Ensure appeals are submitted within payer-specific timeframes Collaborate with clinical departments to gather necessary information for authorization appeals Work cross-functionally with physicians, clinical staff, utilization review, and billing teams to resolve complex denials Stay current on payer guidelines and policy changes that could impact claim reimbursement Ensure compliance with HIPAA, CMS, and payer regulations Provide actionable insights and solutions to leadership and managed care teams Use EMR and billing systems (e.g., Epic, Cerner, Meditech) to retrieve and review account detailsHandle high-stress scenarios calmly and confidently, ensuring productive outcomes and preserving positive relationships Requirements Must live in the Des Moines Metropolitan area Prioritize tasks to meet deadlines while managing multiple assignments simultaneously Handle high-stress scenarios calmly and confidently, ensuring productive outcomes and preserving positive relationships Communicate clearly and effectively in both verbal and written formats Capable of working efficiently in a fast-paced environment while maintaining attention to detail Handle sensitive information with discretion and maintain confidentiality where required Hours Monday- Friday 07:00am -3:30pm Work from home / remote position Onboarding training in office

Perks and Benefits:

Up to 6 Weeks PTO 6 Weeks Off for Family Bonding 8 Paid Holidays Uniform Allowances Profit Sharing Growth Opportunities Weekly Free Catered Lunches Employee Assistance Programs Free Counseling Services Blue 365 Membership with

Health Insurance Wellness Incentives Job Type:

Full-time Benefits:

401(k) 401(k) matching Dental insurance Employee discount Flexible schedule Health insurance Life insurance Paid time off Vision insurance

Schedule:

Monday to Friday Application Question(s): What is your current role and key responsibilities? What relevant experience makes you suited for this position? What about this role interests you? When would you be available to start a new role?

License/Certification:

Certified Professional Coder (Required) Ability to

Commute:

Clive, IA 50325 (Preferred) Ability to

Relocate:

Clive, IA 50325: Relocate before starting work (Required)

Work Location:

Hybrid remote in Clive, IA 50325