Denials Management Specialist

Position Summary: The Denials Management Specialist is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The specialist will work independently while managing their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered. Essential Functions and Responsibilities as Assigned:

1. Monitors denial work queues and reports in accordance with assignments from direct supervisor. Maintains required levels of productivity while managing tasks in work queues to ensure timeliness of follow-up and appeals.
2. Tracks and investigates denial trends/ root cause.
3. Assists with claim audits as necessary.
4. Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.
5. Obtain retro authorizations and submit to payers for reimbursement.
6. Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.
7. As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.
8. Works independently with other departments to resolve A/R and payer issues.
9. Participates in departmental and team meetings involving discussion of A/R processes and trends.
10. Knowledge of payer edits, rejections, rules, and how to appropriately respond to each to resolution.