Business Office Specialist (Denial Appealer) - FT- Days

Clerical, Administrative &Registration Edinburg, Texas


Position at DHR Health


This position is responsible for business office activities which include patient billing, customer service, and transmission of all electronic claims several times a day, with the set up and monitoring of new insurance plans.



  • High School Diploma/GED is required
  • Comprehensive knowledge of healthcare billing.
  • Understands medical terminology.
  • Excellent Customer Service
  • Familiarity with EOB’s and RA’s.
  • Must be able to multi-task, and work with frequent interruptions
  • Good written and verbal communication skills are required
  • Ability to read, write and speak English
  • Ability to communicate clearly and concisely with all levels of management
  • MD billing office experience required, hospital experience preferred.



  • Communicates clearly and concisely; and is able to work effectively with other employees, patients and external parties
  • Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
  • Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
  • Medical Terminology, ICD-9 Codes, CPT Codes, HCPCS code, Modifier knowledge is preferred.
  • Requires reasoning ability, good independent judgment and working with frequent interruptions.
  • Ability to use the internet to obtain information from Third Party Payers or other sources is required



  • Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
  • Perform daily billing, including abstracts, interim bills, late charges, re-bills and split bills
  • Transmits all claims worked by billers to all insurance carriers three times a day
  • Submits professional 1500 claims as needed
  • Works claims that have been placed on hold to ensure bills are released timely.
  • Assist patients with questions and concerns regarding the billing of their accounts.
  • Downloads and posts the electronic remit acknowledgement reports.
  • Works the exclusion and rejection reports from Claims Administrator and makes any needed corrections, re-bill claims and balances daily billing
  • Serves as a resource for billers, collectors, customer service, appeals staff and other departments.
  • Monitors billing not imported report
  • Monitors MD’s with no NPI numbers and locates them in order to update system for billing compliance
  • Monitors Rehab, Oncology billing report and outstanding billing report
  • Monitors billing edits and releases and makes updates as needed.
  • Responds to all mail, email and phone calls in a timely manner.
  • Completes provider applications for payers to set up for electronic billing and payments.
  • Create I-Plans in Paragon and Claims Administrator as needed.
  • Opens tickets with McKesson for issues with Claims administrator and follow up to resolution
  • Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures.
  • Other duties and special projects as needed.



CFO …. Director …. Manager ….. Supervisor