Integrated Pain Management Medical Group, Inc.

Compensation

Full Description

The Denial Prevention Specialist is responsible for proactively identifying, analyzing, and preventing claim denials across all payer categories, with a primary focus on Workers’ Compensation (WC), functional rehabilitation programs (FRP), and pain management services. This role works collaboratively with Patient Access, Coding, Charge Capture, Authorization, Billing, and Clinical teams to ensure claims are submitted accurately and timely, reducing denial rates, improving clean claim performance, and accelerating cash flow. The specialist monitors denial trends, conducts root-cause analysis, develops preventive workflows, and provides ongoing training and feedback to operational teams to ensure compliance with state & federal regulations, OMFS guidelines, and payer-specific requirements. • This is a remote role. We are only hiring in the following states: AZ, CA, NM, NV, OR, TX and WA. What you will do: • Perform daily and weekly analysis of claim edits, front-end rejections, and historical denial data to identify denial trends. • Conduct root-cause analysis for denials related to: • Authorization/Utilization Review (UR) • Coding and modifier accuracy • WC billing rules compliance • Timely filing requirements • Documentation deficiencies • Charge capture errors • Develop and implement denial prevention action plans in collaboration with RCM leadership • Partner with rehabilitation program teams to ensure services are properly authorized documents, and billed according to WC guidelines • Monitor WC claims for common denial triggers such as missing reports, incorrect dates of injury, and authorization mismatches. • Provide regular feedback to scheduling and intake teams to prevent front-end errors that lead to denials • Support RCM leadership with KPI reporting and performance improvement initiatives • Prepare monthly denial-prevention reports for RCM leadership • Maintain denial-prevention tracking dashboard: • Clean claim rate • First-pass resolution rate • Top denial categories • WC denial trends • Assumes other responsibilities as appropriate to the position and organizational needs Qualifications: • High school diploma required; associate or bachelor’s degree preferred • Minimum 3-5 years of healthcare RCM experience, preferably in pain management, rehabilitation, or Workers’ Compensation billing • Strong experience with denial management, front-end revenue cycle processes, and payer guidelines • Experience working with California WC billing strongly preferred • Knowledge of CPT/HCPCS coding, modifiers, and medical billing practices • Understanding of California Workers’ Compensation regulations and OMFS guidelines • Strong analytical and root-cause analysis skills • Experience with multiple EHR/ Practice Management systems (IMS, Nextgen, Athena, eClinicalWorks or similar) • Advanced proficiency in Microsoft Excel (e.g., formulas, pivot tables) and solid skills in other Microsoft Office applications Compensation Range: $28.00 to $32.00 Hourly All compensation ranges are posted based on internal equity, job requirements, experience, and geographical locations. Why You'll Love Working Here: • Amazing work/life balance • Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO) • 401(K) Plan with Employer Matching • License & Tuition Reimbursements • Paid Time Off • Holiday Pay & Floating Holiday • Employee Perks and Discount Programs • Supportive environment to help you grow and succeed Boomerang Healthcare (BHC) is a multidisciplinary and comprehensive team of experienced, committed healthcare providers that treat pain. Our team of doctors approaches each patient with one goal in mind: to help patients return to normal daily activities. We work with our patients to identify the cause of their pain and create a personalized treatment plan, recognizing that no two patients are alike, and neither is their pain. Our providers create a comprehensive care plan, then monitor, manage and coordinate patient access to health services at BHC. Boomerang Healthcare strives to be a diverse workforce that reflects, at all job levels, the patients we serve. We are an equal opportunity employer. Boomerang Healthcare is committed to compliance with the American Disabilities Act. If you require reasonable accommodation during the application process or have a question regarding an essential job function, please contact us. Monday-Friday, 8am-5pm 40