Medical Claims Denials Specialist

Company: Kforce Finance and Accounting ( Learn More )

General Information
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Job Description


Kforce has a client seeking a Medical Claims Denials Specialist in Portland, Oregon (OR). The Denial Specialist role focuses on working denied claims. DDE claims follow up for Medicare Part A clients. Work clearinghouse rejections for specified region. Focus directed to categories that support the AR Relief Curve, the Days in AR metrics (
  • Resolve clearinghouse rejections maintain rejection numbers within outlined SLA
  • Utilize all tools available to understand status of a claim at the 30 to 45-day mark depending on the payer; check websites, IVR systems, and phone calls to the payor as needed
  • Work claims as prioritized by the team based on knowledge of the client, their status with payers and knowledge of difficult payers for that client (WC, Medicaid, TPA's, etc.)
  • Communicate problems with payers to your team lead and determine if client involvement is needed in understanding their relationship to the payer
  • Keep claim regulation knowledge up to date
  • Be comfortable with working on multiple projects simultaneously
  • Recognizes, analyzes and reports on data related to underpayments, denials, revenue opportunities and revenue leakage
  • Responds to client tasks regarding AR or patient accounts
  • Secondary Duties and Responsibilities:
  • Be very inquisitive in regards to the intentions of the client and insurance company
  • Be passionate and assertive in problem solving
  • Job Requirements


    • Bachelor's degree preferred
    • 1 to 2 years' experience in insurance, healthcare or medical billing
    • Must be a role model of Client's Core Values: Be Honest and Transparent; Coach More, Shoot Less; Deliver Exceptional Results; Enjoy the Journey; Fail Fast, Succeed Faster; and Find a Better Way
    • Have prior knowledge of medical necessity and LCD's (local coverage determinations) and attain new knowledge regarding the claim process
    • Optimizes Work Processes, Customer Focus, Nimble Learning, Collaborates, and Instills Trust
    • Experience in managed care contracts, reconciling patient accounts, and balancing payment transactions against contract rates and terms is strongly desired
    • Keen attention to detail with ability to spot trends and proactively reduce denials
    • Critical thinker with demonstrated ability to perform root cause analysis, problem solve, prepare and implement action plans and lead improvement initiatives
    • Strong oral and written communication skills
    • Proficiency in the use of PCs and MS Office suite
    • Ability to adapt to a changing and dynamic environment
    • Comfortable working in both individual and team settings
    • Ability to interpret and implement regulatory standards
    Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.