Denial Management Specialist - NC Only

Abound Health is seeking a Denial Management Specialist to join our Revenue Cycle Management team in a remote capacity. In this role, you will be responsible for analyzing, tracking, and resolving claim denials to ensure timely reimbursement and compliance with payer requirements. You will collaborate closely with internal teams and external payers to identify root causes, implement corrective actions, and reduce future denials.

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  Review and analyze denied claims to identify root causes and resolution steps.

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  Collaborate with revenue cycle and clinical teams to correct errors and resubmit claims.

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  Communicate with payers to clarify denial reasons and submit appeals as appropriate.

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  Track denial trends, appeal status, and outcomes with accurate documentation.

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  Develop strategies to reduce denial rates and improve first-pass claim acceptance.

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  Prepare reports on denial metrics, financial impact, and corrective actions for leadership.

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  Monitor compliance with payer guidelines, Medicaid regulations, and internal policies.

• 5+ years of experience in healthcare billing, denial management, or revenue cycle operations.

• Strong analytical, problem-solving, and attention-to-detail skills.

• Excellent written and verbal communication skills.

• Ability to collaborate effectively with internal teams and external payers.

• Proficiency in MS Office (Excel, Word, Teams) and EHR systems (OnTarget preferred).

• Knowledge of Medicaid and managed care requirements for I/DD services preferred.

• Associate or Bachelor’s degree in Healthcare Administration, Business, or a related field preferred.

Abound Health is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity or expression, protected veteran status, disability/handicap status, or any other legally protected characteristic.

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