Claim Denial Specialist

Company Overview
New Horizon Care Centers, Inc. is a reputable nonprofit organization dedicated to providing compassionate, trauma-informed behavioral health and substance use treatment services to individuals and families in need. Established in 1980, the organization offers a comprehensive range of residential and outpatient programs, mental health counseling, and specialized support services aimed at fostering recovery, dignity, and community well-being.

Job Description: Claim Denial Specialist

Position: Full time, Monday – Friday, 8:00am – 4:30pm, Hourly

Place of Work: On-site

Supervisor(s): Billing Manager

Objective:

Responsible for investigating, appealing, and resolving denied insurance claims to recover lost revenue by correcting errors, gathering medical documentation, and overturning payer decisions.

Qualifications/Skills:

• High school graduate or equivalent and three (3) years of progressive on-the-job experience in medical billing required.
• Proficient with Microsoft Office suite (in particular, Excel, Teams, and SharePoint), electronic health record (EHR) systems and billing software (especially Qualifacts Insync HealthCare).
• Experience in ICD-10, medical terminology, Medicaid, Medicare, and commercial insurance billing guidelines and contracting.
• Experience in behavioral healthcare and Medicare billing highly preferred.
• Needs strong interpersonal communication, organizational, and multitasking abilities.
• Must be detail-oriented and maintain strict ethical and professional boundaries.
• Willing to work in a change-based environment, use independent critical thinking, and be self-directed with little supervision needed.
• Possess the ability to manage several projects simultaneously with exceptional follow-through.
• Must be able to pass a drug test.

Special Requirements: Stair climbing, sit/bend at a desk majority of the workday.

Responsibilities:

• Reviewing Aged Trial Balance (ATB) to resolve unpaid claims in 31-365 day buckets.
• Analyzing Explanation of Benefits (EOB) statements and payer portals to pinpoint reasons for claim denials.
• Drafting and submitting formal appeals using coding evidence and supporting medical records (when required by the payer).
• Monitoring appeal timelines, escalating unresolved disputes, and documenting all actions in the electronic health record (EHR) patient accounting system.
• Identifying recurring denial patterns, reporting these patterns to the Billing Manager, and recommending process improvements to prevent future rejections.
• Collaboration with Billing and A/R teams, case managers, and clinicians.
• Attend all Finance Team and payer meetings.
• Maintain confidentiality per CFR part 2, HIPAA, ethical conduct and professional boundaries.
• Maintain strict ethical and confidential guidelines for NHCC, Inc. according to all applicable laws and agency policies.
• Maintain an understanding of NHCC, Inc. policies and procedures.
• Maintain an understanding and implement the use of program policies and procedures for programs/contracts awarded to NHCC, Inc. (Managed Care Organizations, commercial insurance carriers, Substance Abuse Block Grant funding, etc.).
• Other duties as assigned by Billing Manager or CEO.

Pay: $23.00 - $25.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

People with a criminal record are encouraged to apply

Experience:

• Medical billing: 3 years (Required)
• Claim Denial Management: 1 year (Preferred)
• Medicare/Medicaid Billing: 1 year (Required)

License/Certification:

• Medical Billing Certification (Preferred)

Work Location: In person

Salary : $23 - $25