Claims Denial Specialist

EMPOWER BEHAVIORAL HEALTH LLC 6222

Ih 10 West, San Antonio, TX 78201

Description:

Reports to:

Revenue Cycle Manager FLSA Status:

Exempt/Full Time Compensation:

$52,000-$60,000 annually

Travel/Location:

Onsite - in office, based out of our Corporate Location in

San Antonio, TX Job Summary:

The Claim Denial Specialist at Empower Behavioral Health (EBH) plays a critical role in ensuring the financial health of the organization by managing and resolving denied insurance claims. This individual is responsible for identifying, analyzing, and correcting claim issues to ensure accurate and timely reimbursement. Working in a dynamic and fast-paced environment, the Claim Denial Specialist is a key contributor to the revenue cycle team and supports the organization's mission of delivering quality patient care.

Duties and Responsibilities:

Review and analyze denied or rejected insurance claims for accuracy and resolution Research and identify root causes of denials, trends, and recurring issues Prepare and submit appeals with appropriate documentation in accordance with payer guidelines Communicate effectively with insurance companies to clarify denial reasons and resolve discrepancies Collaborate with clinical and administrative teams to gather supporting information for appeals Monitor and track appeal statuses and outcomes, ensuring timely follow-up Maintain up-to-date knowledge of payer policies and denial codes Document all denial resolution activities in the Practice Management System Escalate recurring or complex denial trends to the RCM for further action Contribute to monthly reports and participate in billing team meetings as needed

Competencies:

Analytical Thinking and Problem Solving Attention to

Detail Knowledge of Insurance Guidelines and Appeal Processes Strong Written and Verbal Communication Organizational and Time Management Skills Customer Service Orientation Results-Driven Requirements:

Education and Experience:

Required:

High school diploma or equivalent Minimum of one year of healthcare billing and claims denial experience Strong knowledge of insurance claim submission and denial processes Familiarity with electronic remittance advice and explanation of benefits Proficiency in using payer portals and navigating practice management systems

Preferred:

Experience with Central Reach practice management system Experience working in an administrative setting Experience working in a growing organization Empower Behavioral Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.