Clinical Denial Specialist

Job Family:

Medical Assistant

Travel Required:

None

Clearance Required:

None

What You Will Do:

• Claims & Documentation

  • Follow up on pending authorizations and denied claims; assist in appeals when necessary.

  • Frequently visit payor portals for updates on cases

  • Document status of claims within the EMR system.

• Communication

  • Respond to patient inquiries regarding billing and insurance processes in a professional manner.

• Coordination & Compliance

  • Collaborate with clinical staff, case managers, and revenue cycle teams to ensure timely updates and accurate records.

  • Maintain compliance with HIPAA and hospital policies, safeguard patient information.

• Administrative Support

  • Update and maintain data in electronic health records (EHR) and billing systems.

  • Generate reports on claim status, authorizations, and reimbursement trends for management review.

What You Will Need:

• High school diploma or equivalent; medical assistant certification preferred.

• Minimum 3+ years of experience in healthcare administration, insurance verification, or medical billing.

• Knowledge of medical terminology, CPT/ICD coding, and payer authorization processes.

• Proficiency in EHR systems and insurance portals.

• Strong organizational, communication, and problem-solving skills.

What Would Be Nice To Have:

• Medical Assistant Certification

• Excel/PowerPoint Skills

#LI-DNI 

The annual salary range for this position is $49,000.00-$81,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com.  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.  Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact recruiting@guidehouse.com. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.