Denial Management Specialist

Role Description

Are you a numbers aficionado, skillful in maximizing costs and minimizing expenses? Finance and Accounting focuses on the organization's financial management strategies and execution. If this piques your interest, read more below and apply today!

Shift: Monday-Friday 8:00am-4:30pm

• Reviews and researches claims in which a denial payment has been received from the payer in a timely manner
• Manages and develops necessary department and executive level reporting
• Identifies the root cause of the denial and addresses the denial issue with the appropriate department (Billing, Clinical Documentation, Coding)
• Utilizes all appropriate systems to effectively research claims and complete steps to submit information necessary to process or appeal claims
• Investigates and ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims
• Completes and requests adjustments to a claim, as appropriate, based on the dollar threshold of the adjustment
• Reviews, works and reports all claims that have aged more than the specified grace period stipulated in policies and/or contacts
• Organizes work/resources to accomplish objectives and meet deadlines
• Demonstrates problem-solving skills related to denial analysis
• Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively to obtain necessary information to address denial management issues
• Meets productivity requirements to ensure excellent service is provided to customers
• Maintains compliance with established corporate and departmental policies and procedures
• Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, customers and co-workers
• Identifies all denial trends and provides education of steps to prevent future avoidable denials
• Initiates/manages all appeals in a timely manner
• Organizes the work flow to ensure that denials are worked according to timely filing deadlines and conditions of payment
• Communicates all denial trends and denial increases to direct supervisor in order to positively affect the volume of denials
• Builds relationships with payors
• Completes special projects as assigned by Supervisor/Manager

Qualifications

• High School Diploma required; Bachelors Degree preferred
• At least three to five years of experience in revenue cycle and/or billing experience
• Denial Management and/or electronic billing experience are preferred
• Highly motivated individual with attention to detail in fast paced environment
• Good internal/external customer communication skills required
• Able to work independently and collaboratively as a team player
• Systems include Excel, Power Point, Zirmed billing system

Salary Range

USD $18.00 - $22.00 / Hour