Revenue Cycle Clinical Denials Specialist (Fort Worth, TX)

Paladin Consulting is currently hiring a ­­­­­­­­­­­­­­­­­­­­ Revenue Cycle Clinical Denials Specialist to join our team working onsite at our client's office located in Fort Worth, TX. 

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Job Title: Revenue Cycle Clinical Denials Specialist
Work Location: Fort Worth, TX 
Duration: 3 month contract with option to extend 
Education/Experience Required: High School/Equivalent; Prior experience with Epic Systems Revenue Cycle Solutions (HB Resolute) required

Job Responsibilities: 

• Execute advanced tasks related to the management of clinical denials and conduct in-depth root cause analysis.
• Address claim denials related to authorization, referral, late notifications, level of care, medical necessity, and other specified denials.
• Perform comprehensive reviews of claim denials, account reconciliations, and clinical documentation to identify root causes and devise appropriate resolutions.
• Draft and submit professional appeals with persuasive arguments grounded in clinical documentation and payor policies.
• Ensure that appeals and reconsiderations comply with payor guidelines and regulations for timely submission.
• Monitor denial trends, pinpoint recurring issues, and recommend process improvements to minimize future denials.
• Engage in audit-related and compliance activities and assist with other administrative tasks as necessary.
• Manage and communicate denial and appeal activities to stakeholders and report trends to Revenue Cycle leadership.
• Coordinate activities affecting hospital reimbursement and assist in documenting key processes.
• Work autonomously to influence hospital reimbursement and maintain documentation of processes under Revenue Integrity leadership.

Skills & Qualifications: 

• High School diploma or equivalent education.
• Ability to formulate effective arguments for clinical denials related to hospital services.
• Understanding of health plan operations, reimbursement methods, payor contracts, and clinical policies.
• Knowledge of state, federal, and compliance regulations related to coding and billing.
• Strong understanding of medical billing principles, insurance coding, medical terminology, and appeals processes.
• Excellent written and oral communication skills for managing complex appeals and denials.
• Commitment to ensuring high customer satisfaction for both internal and external stakeholders.
• Basic math skills and understanding of healthcare financial and accounting practices.
• Ability to maintain strong relationships with team members influencing financial outcomes.
• Analytical skills, attention to detail, and strong problem-solving abilities.
• Proficiency with medical decision-making criteria tools such as InterQual and Milliman Care Guidelines.
• Adaptability to constant changes and capability to act as a change agent.
• Experience with Epic Systems Revenue Cycle Solutions (HB Resolute) is required.

For more information or to explore other opportunities, visit us at www.paladininc.com.