Medical Billing Professional Cardiology Denial Specialist

Summary Under general supervision of the Follow-up Supervisor, performs all duties necessary to follow up on outstanding claims and correct all denied claims for a large physician multi-specialty practice. Core Success Factors Instill Trust and Value Differences Patient and Community Focus and Collaborate Responsibilities Review all denied claims, correct them in the system and send corrected/appealed claims as written correspondence, fax or via electronic submission. Identify and analyze denials and enact corrective measures as needed to effectively communicate and resolve payer errors. Continually maintain knowledge of payer‑specific updates via payer's listservs, provider updates, webinars, meetings and websites. Understand and maintain compliance with HIPAA guidelines when handling patient information. Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials. Report to supervisor the identification of denial trends resulting in revenue delays. Answer telephone inquiries from third‑party payers; refer all unusual requests to supervisor. Retrieve appropriate medical‑records documentation based on third‑party requests. Refer all accounts to supervisor for additional review if the account cannot be resolved according to normal procedures. Work with management to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department. Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures and objectives of the system and affiliates. Perform other related duties as required. Minimum Qualifications Equivalent to a high‑school graduate. Knowledge of third‑party billing including ICD, CPT, HCPCS and 1500 claim forms. Demonstrated critical‑thinking, diplomacy and relationship‑building skills. Highly developed communication skills, successfully demonstrated in working with a wide variety of people in individual and team settings. Demonstrated problem‑solving and inductive reasoning skills that produce creative solutions for operational inefficiencies. Experience One to three years of relevant experience in professional billing preferred. Experience with Epic a plus. Independent Action Incumbent generally establishes own work plan based on pre‑determined priorities and standard procedures to ensure timely completion of assigned work. Problems needing clarification are reviewed with supervisor prior to taking action. Pay Range $19.97-$32.96 EEO Statement Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Location Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903 Work Type Monday-Friday 7:30-4 Work Shift Day Daily Hours 8 hours Driving Required No #J-18808-Ljbffr