Us Healthcare Claim Denial Specialist

13 hours ago


Islamabad, Islamabad, Pakistan Wellnite Full time

We are seeking a Claim Denial Specialist with deep knowledge of the US healthcare system and insurance processes—specifically for mental and behavioral health claims. In this role, you will be responsible for identifying, analyzing, and resolving denied insurance claims to ensure timely reimbursement and reduce revenue cycle delays.

Key Responsibilities

Review Explanation of Benefits (EOBs) and denial codes for accuracy and appeal opportunities
Contact insurance companies to understand denial reasons and clarify claim status
Prepare and submit corrected claims and appeals with supporting documentation
Collaborate with internal billing, eligibility, and provider teams to resolve recurring issues
Track and follow up on outstanding appeals and reprocessed claims
Maintain detailed records in the billing system and report denial trends or payer issues

Qualifications

2+ years of experience handling claim denials and appeals in a healthcare billing or revenue cycle role
Strong understanding of mental health billing codes, parity laws, and payer requirements (e.g., CPT, ICD-10, modifiers)
Familiarity with insurance portals (e.g., Availity, payer sites) and clearinghouses
Knowledge of HIPAA, insurance EOBs, and denial management best practices
Detail-oriented, organized, and capable of managing multiple priorities independently
Strong communication and documentation skills

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