Randstad USA · 16 hours ago
Denial Prevention Specialist (Remote - DFW Local)
United States
Contract
Remote
Entry, Mid Level
$22.92/hr - $22.92/hr
2+ years expRandstad USA is seeking a Denial Prevention Specialist to join their team. In this role, you will investigate denied claims, file appeals, and work closely with insurance carriers to ensure proper reimbursement.
ConsultingHuman ResourcesInformation TechnologyRecruiting
Hiring Manager
Carmen Kier
Responsibilities
Claim Investigation: Review EOBs to determine how claims were managed and identify reasons for denials or partial payments
Carrier Liaison: Contact insurance carriers (Managed Care, Commercial, Medicare, and Medicaid) via phone and web to resolve unpaid accounts over 30 days
Strategic Appeals: Research, prepare, and submit formal appeals to secure reconsiderations for denied services
Contract Interpretation: Apply knowledge of Managed Care contracts and government regulations to ensure payment validation
Technical Support: Resolve provider NPI/TPI claim edits and rejections
Research and follow up on denials and requests for additional information
Perform payment validation utilizing internal and external resources
Contact patients when necessary to gain additional information required to resolve outstanding insurance balances
Manage Claim Edit and Team Lead work queues efficiently
Qualification
Required
Applicants must live within the Greater Dallas-Fort Worth area
Must have a minimum of 2–4 years of experience in medical claims recovery and/or collections within a healthcare or insurance environment
High School Diploma OR Associate's Degree
Proficient in reviewing Explanation of Benefits (EOB)
Strong knowledge of Managed Care, Commercial, Medicare, and Medicaid payors
Excellent verbal and written communication skills for carrier correspondence and patient interaction
Company
Randstad USA
Randstad US is a wholly owned subsidiary of Randstad Holding nv, a global provider of human resources solutions.
1001-5000 employees
H1B Sponsorship
Randstad USA has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (754)
2022 (776)
2021 (1143)
2020 (1749)
Funding
Current Stage
Late StageLeadership Team
Lindsay Bennett
Executive Business Partner to CEO, North America
Traci Fiatte
CEO, Professional and Commercial Staffing
Recent News
2025-02-18
PR Newswire
2025-02-06
Company data provided by crunchbase