Job Description

About Us

Iowa Digestive Disease Center and Iowa Endoscopy Center are proud to serve the community and surrounding area with regard to digestive health needs. Our endoscopy center is one of only three centers in Iowa recognized by the American Society for Gastrointestinal Endoscopy. The American Society for Gastrointestinal Endoscopy is known as the leader in setting standards for excellence in gastrointestinal endoscopy and has designed the only national program recognizing quality and safety in the practice of gastrointestinal endoscopy.



Our center has also been accredited by the AAAHC, having met their rigorous quality and safety standards. AAAHC accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization's commitment to meeting certain performance standards.



Our board-certified physicians specialize in: Gastroenterology, Hepatology, Diagnostic Endoscopy, Therapeutic Endoscopy, Infusion, and Advanced Therapeutics.

Education Requirements

High school graduate or equivalent is required Certified Professional Coder (CPC) is required Accounts receivable and professional billing experience required LPN or RN licensure is preferred

Job Summary

The

Accounts Receivable/

Denial Management Specialist

plays a critical role in our Accounts Receivable department, ensuring appropriate reimbursement for healthcare services by managing clinical claim denials. This advanced-level position involves comprehensive analysis of denied claims related to referrals, authorizations, medical necessity, non-covered services, and more. The specialist independently reviews medical records, payer policies, and account notes to determine the appropriate resolution--whether that be a revised claim, retro-authorization, appeal submission, or closure.



Key responsibilities include crafting detailed, professional appeal letters grounded in clinical documentation, payer policy, and contract terms, submitting appeals timely, and tracking them through resolution. The role also involves identifying trends in denials, suggesting process improvements, and maintaining compliance with audit and regulatory requirements.

Responsibilities

Conduct thorough reviews of medical records, denial letters, and payer documentation Determine the root cause of denial (authorization, coverage, coding, medical necessity, etc.) Draft and submit comprehensive appeal letters using clinical rationale, payer policies, and supporting documentation Ensure appeals are submitted within payer-specific timeframes Collaborate with clinical departments to gather necessary information for authorization appeals Work cross-functionally with physicians, clinical staff, utilization review, and billing teams to resolve complex denials Stay current on payer guidelines and policy changes that could impact claim reimbursement Ensure compliance with HIPAA, CMS, and payer regulations Provide actionable insights and solutions to leadership and managed care teams Use EMR and billing systems (e.g., Epic, Cerner, Meditech) to retrieve and review account details Handle high-stress scenarios calmly and confidently, ensuring productive outcomes and preserving positive relationships

Requirements

Must live in the Des Moines Metropolitan area Prioritize tasks to meet deadlines while managing multiple assignments simultaneously Handle high-stress scenarios calmly and confidently, ensuring productive outcomes and preserving positive relationships Communicate clearly and effectively in both verbal and written formats Capable of working efficiently in a fast-paced environment while maintaining attention to detail Handle sensitive information with discretion and maintain confidentiality where required

Hours

Monday- Friday 07:00am -3:30pm Work from home Onboarding training in office

Perks and Benefits:

Up to 6 Weeks PTO 6 Weeks Off for Family Bonding 8 Paid Holidays Uniform Allowances 401(k) with 4% matching Profit Sharing Growth Opportunities Weekly Free Catered Lunches Employee Assistance Programs Free Counseling Services Blue 365 Membership with Health Insurance * Wellness Incentives