EHPB Denial Management Spec

Job Title

Investigates health plan denials to determine appropriate action and provide resolution.

Primary Duties

• Investigate insurance denials to identify action necessary.
• Corrects claims based on denials, complaints and audits and rebills using payor approved process.
• Determines need for payor appeal and sends individualized appeal letter. Monitors appeals for resolution.
• Adjusts denials determined to be appropriate using the corresponding adjustment code(s).
• Works the accounts that meet denial management criteria and coordinates resolution with other departments.
• Logs all denials including actions and resolution on Denial spreadsheet.
• Identify denial pattern to identify potential process improvement.
• Produces quarterly denial reports.

License, Certification, Education or Experience

REQUIRED for the position:

• High School graduate or equivalent.
• 1-year previous experience in professional billing.
• Knowledge and experience in working with health care insurers and their reimbursement systems, especially Medicare, Medicaid, Workers Compensation, Motor Vehicle and contract payers.
• A good understanding of CPT, Modifiers, HCPC, ICD-10 codes and medical terminologies.
• Demonstrated problem solving ability.
• Ten-key by touch DESIRED for the position: College degree/Vocational training in billing or business

Benefit Information

Choices that care for you and your family At EvergreenHealth, we appreciate our employees' commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

Medical, vision and dental insurance

On-demand virtual health care

Health Savings Account

Flexible Spending Account

Life and disability insurance

Retirement plans (457(b) and 401(a) with employer contribution)

Tuition assistance for undergraduate and graduate degrees

Federal Public Service Loan Forgiveness program

Paid Time Off/Vacation

Extended Illness Bank/Sick Leave

Paid holidays

Voluntary hospital indemnity insurance

Voluntary identity theft protection

Voluntary legal insurance

Pay in lieu of benefits premium program

Free parking

Commuter benefits