We are an Equal Opportunity Employer. All qualified applicants are considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state or local law. Not Accepting Referrals
Clinical Denials Specialist
Location
United States
Posted
7 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Clinical Denials Specialist
firstsourc
Role Description The goal of the Clinical Denial Specialist is to successfully manage claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, and other clinically related denials, as assigned. The specialist will review claims and make recommendations for claim resubmission, retro authorization, written appeal or if no action is needed. The Clinical Denial Specialist will write / submit professionally written appeals including arguments based on the clinical documentation, payer medical policies and contract language. The appeals will be submitted timely and tracked for outcome and trends. Qualifications - Associates Degree in a business or healthcare related field. - Registered Nurse (RN) Certification with experience in care management, utilization review, prior authorization and appeals. - Electronic Health Record Experience with various platforms (Epic, Cerner, Meditech). - Knowledge of all insurance payers preferred. - Proficient PC knowledge and the ability to type 30-40 wpm. - Professional written and verbal communication skills. - Capacity to prioritize multiple tasks in a busy work environment. - Organization and time management skills. - Capability to present oneself in a courteous and professional manner at all times. - Ability to stay on task with little or no supervision. Requirements - Research assigned payer denials (referral, authorization, notification, medical necessity and non-covered services). - Independently write / submit professional appeal letters in accordance with client and payer policies. - Prepares reports for management review and identifies trends. - Reviews and understands utilization review and coverage guidelines for multiple payers. - Identify process improvement opportunities. - Monitor denial and appeal outcomes and trends, and report findings to management. - Ensure all denial management activities comply with federal, state and payer regulations, including HIPAA requirements. Benefits - Medical - Vision - Dental - 401K - Paid Time Off
Related Guides
Related Categories
Related Job Pages
More Accounts Receivable Jobs
Accounts Receivable Specialist
Oral Surgery PartnersThe above statements are intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. OPS’s management reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
Role Description The Accounts Receivable Specialist is responsible for managing the full cycle of accounts receivable processes to ensure accurate and timely collection of payments. This role oversees the invoicing of clients, reconciliation of accounts, payment posting, and resolution of billing discrepancies. The specialist communicates regularly with internal teams and external customers to address outstanding balances, verify account information, and support efficient cash flow operations. A strong attention to detail, excellent organizational skills, and the ability to work in a deadline-driven environment are essential for success in this position. Qualifications - High school diploma or GED required; associate or bachelor’s degree in accounting, finance, business administration, or a related field preferred. - 1–3 years of experience in accounts receivable, medical billing, insurance claims processing, or a similar office/finance role. - Prior oral surgery experience is required. - Experience working with insurance payers, claim submission processes, and reimbursement guidelines are strongly preferred. - Familiarity with electronic health records (EHR), practice management systems, or billing software (WINOMS) required. - Dental or medical billing experience (if relevant to your setting) is a plus. Requirements - Strong knowledge of accounts receivable practices, payment posting, aging reports, and denial management. - Understanding of CPT, CDT, ICD-10 codes, and insurance terminology (if medical/dental setting). - Excellent attention to detail and accuracy in data entry and financial reconciliation. - Strong analytical and problem-solving skills, especially when reviewing discrepancies or denial trends. - Ability to communicate professionally with patients, insurance representatives, and internal team members. - Proficiency with Microsoft Office Suite, especially Excel, and comfort learning new software systems. - Ability to prioritize tasks, manage time effectively, and work in a fast-paced, deadline-driven environment. - Strong organizational skills with the ability to maintain accurate and confidential records. - Ability to work independently and collaboratively as part of a team. - Knowledge of HIPAA regulations and a commitment to maintaining patient confidentiality. - Willingness to participate in ongoing training and adapt to changing policies, procedures, and payer requirements. Benefits - Medical, Dental, and Vision Insurance plans for full-time employees. - Two out of the three medical plans offered include Health Savings Account (HSA) eligibility. - Company-paid Life, AD&D, and Long-Term Disability coverage. - Additional Voluntary Life and AD&D Insurance for you and your family. - Voluntary Short-Term Disability Insurance available. - Dependent Care Flexible Spending Account (FSA) offered. - 401(k) savings plan starting with the first paycheck. - Employer 401(k) contribution and Profit Sharing after six months of employment. - PTO and 8 Paid holidays for full-time employees.
Accounts Receivable Client Onboarding And Customer Specialist
AlphaSense IndiaAlphaSense is an equal-opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals. All employees share in the responsibility for fulfilling AlphaSense’s commitment to equal employment opportunity. AlphaSense does not discriminate against any employee or applicant on the basis of race, color, sex (including pregnancy), national origin, age, religion, marital status, sexual orientation, gender identity, gender expression, military or veteran status, disability, or any other non-merit factor. This policy applies to every aspect of employment at AlphaSense, including recruitment, hiring, training, advancement, and termination. In addition, it is the policy of AlphaSense to provide reasonable accommodation to qualified employees who have protected disabilities to the extent required by applicable laws, regulations, and ordinances where a particular employee works.
Role Description Reporting to the Billing & Collections Manager, the position will be the primary point of contact for a variety of AR related activities focused on resolving client communications regarding billing and collections inquiries, as well as internal requests regarding the same. This role will be responsible for overseeing all vendor onboarding and third-party platform management. With an emphasis on prompt and accurate communications, the ideal candidate will be able to strictly adhere to our company's SLA standards and ensure every message is escalated accordingly if it cannot be actioned in real time directly. You will work as part of a growing team at a well-funded growth-stage tech company, and you will have direct communications with clients and a number of internal teams. There will be significant opportunity to advance your career as the company scales. Qualifications - Preference for a candidate with a BCOM / MCOM / BBA / MBA in Finance. - 1+ years of experience in O2C collections, Revenue recognition & reconciliation, and Email Queue or Case Management. - Preference for candidates who have worked with Salesforce and NetSuite. - Primary Skills: Excellent Written and Verbal Communication, Data Management, Customer Service, Billing and Collections Experience, Problem Solving and Multitasking. - Secondary Skills: Time Management Skills, Ownership of case management, Excel and Gsuite. Requirements - Minimum 1 years’ experience in AR, O2C, and collections process, whether directly as a biller, a collections specialist, or a queue management specialist. - Advanced proficiency in Excel is encouraged. - Strong analytical skills are essential; the ideal candidate will have a keen eye for detail and will not allow emails or cases to fall through the cracks. - Strong oral and written communication skills in English with the ability to effectively gather and convey information via e-mail or phone with people located in other non-local offices and in different time zones. - Experience with Maxio, NetSuite, Sage Intacct, and Salesforce will be preferred. - The ideal candidate will be a self-motivated, proactive, deadline-oriented, fast learner, who is an organized, dedicated, flexible, hands-on team player with excellent problem-solving skills. - "Roll-up-the-sleeves" approach is required. Comfortable in an unstructured, dynamic, fast-paced environment. - Extended hours required during peak business periods – financial close, audit periods, and as required by management. Key Responsibilities - Email Queue Management: - Will be responsible for keeping the combined Billing & Collections email queue within 24 business hours SLA. - Work as the primary point of contact for all new email threads to ensure routine questions and vendor onboarding requests are dealt with in a timely manner or escalated internally where appropriate. - Handle the completion of Banking Forms and provide other such Financial documentation such as W9’s, Tax Certificates, etc. - Resubmit invoices through the billing system by email or by vendor portal as needed if the client provides updated billing information post sale/renewal. - Respond to urgent escalation requests and flag internally the appropriate party for support, where needed. - Ensure all open cases are being managed by the team and actioned in a timely manner, once assigned. - Vendor Onboarding: - Own the process of vendor onboarding for AlphaSense and its clients. - Review, validate, and maintain vendor records, legal names, tax IDs, addresses, and contact information. - Provide documents such as W-9, 10F forms, NO PE certificates, banking information, COI, TRC etc. - Ensure accurate vendor creation in procurement systems (SAP, Oracle, Ariba, Coupa, Tungsten, Ramp, Wise etc). - Perform high-importance confirmations including bank verification and TIN validation. - Hands-on Experience in NetSuite and Salesforce. - Contract Review: - Review contract and SFDC data, audit sales orders and invoices within the billing system. - Ensure compliance with company policies and procedures. - Understand contract structure, billing practices, and customer policies from both a customer-facing and a finance department perspective. - Resolve simple billing issues without escalation and know when to flag a case for internal audit by the biller and management team per specified protocols. Benefits - Immediate Joiners will be preferred.
Accounts Receivable / Accounts Payable Specialist
PavagoPavago specializes in connecting businesses with top-tier offshore talent in operations, sales, and marketing, offering a comprehensive recruitment solution designed to reduce cost
Role Description We’re hiring for our client, a growing U.S.-based company, seeking an Accounts Receivable / Accounts Payable Specialist (AR/AP) to own the day-to-day flow of money in and out of the business. This is a high-impact, execution-driven accounting and finance operations role where accuracy, speed, organization, and follow-through are critical. You will: - Process invoices and payments - Manage collections and vendor payments - Maintain clean, audit-ready financial records - Support reconciliation and month-end accounting workflows If you’re detail-oriented, highly organized, and comfortable handling high transaction volumes in fast-paced environments, this role could be a strong fit. Qualifications - 2+ years of experience in Accounts Receivable - 2+ years of experience in Accounts Payable - 2+ years of experience in Bookkeeping - 2+ years of experience in Accounting support - Experience with at least one of the following: QuickBooks, NetSuite, SAP, Xero - Intermediate Excel or Google Sheets skills: VLOOKUP, Pivot Tables - Familiarity with invoicing workflows, payment processing, reconciliations, AR/AP operations Requirements - Multi-currency AR/AP experience (Nice to Have) - Experience with Bill.com and Tipalti (Nice to Have) - Background in SaaS, real estate, or professional services (Nice to Have) - ERP migration or accounting automation experience (Nice to Have) Benefits - High ownership over financial operations - Structured workflows and clear processes - Opportunity to grow into Senior Accounting or Finance Operations - Exposure to modern accounting systems and ERP tools Key Metrics (KPIs) - Invoice accuracy with less than 1% error rate - On-time AP payments (Net 30/45/60) - AR collections within target DSO - Timely reconciliations for month-end close - 100% audit-ready documentation Interview Process - Initial Phone Screen - Recruiter Interview - Practical Task (Reconciliation / AR Aging Scenario) - Client Interview - Offer & Background Verification Apply Now If you thrive in structured, detail-heavy roles and take pride in maintaining clean, accurate financial records, this is a strong opportunity to step into a high-responsibility AR/AP role.
Role Description In this role, you'll manage the day-to-day collections process: - Reaching out to clients via email and phone - Sending monthly statements - Reconciling billing issues with internal teams - Serving as a reliable, relationship-focused point of contact for outstanding accounts You'll work cross-functionally with Billing and Account Management to keep things running smoothly while delivering the hospitality-forward service Steno is known for. Qualifications - 1+ years of A/R and collections experience — a hospitality mindset is key - Comfortable on the phone throughout the day, building client relationships while managing collections - Strong Excel skills (a must!) — bonus points for familiarity with Looker, Zendesk, or HubSpot - Thrive working independently and navigating ambiguity - Fluent in remote tools like Google Workspace, Slack, and Zoom - A critical thinker who can find creative solutions to day-to-day challenges - Can work through detailed processes efficiently without losing organization Application Information Steno is an equal opportunity employer; we do not discriminate on the basis of characteristics protected by law. Employment decisions are based on qualifications, merit, and business needs. Applicants needing special assistance or accommodations for interviews or website access should contact us at accommodations@steno.com . Information provided to Steno, such as professional credentials and skills, educational and work history, the results of technical skills assessments or working exercises, and other information included in an application, is collected, analyzed, and stored in our system. Steno personnel will always have a steno.com email or contact you via Rippling Recruiting. Background checks are only conducted after an offer is extended. If you haven’t received an expected communication, check your spam. Steno uses AI-assisted tools for this role to identify and prioritize candidates whose experience aligns with the role. All hiring decisions are made by our People team.
