Denial Prevention Specialist

Denial Prevention Specialist

Software Guidance & Assistance, Inc., (SGA), is searching for a Denial Prevention Specialist for a contract assignment with one of our premier healthcare clients in Weatherford, TX. This is primarily a remote position, however there are times the employee might have to come into the office for training, team building events or as requested by their supervisor or manager.

Responsibilities:

• The successful candidate will review, research, resolve claim denials and appeals for various insurance companies while identifying payment trends in an effort to maximize collections.
• Capable of reviewing Explanation of Benefits (EOB) from payors to determine how the claims were managed.
• Contacting insurance carriers to check on the status of claims, appeals, and insurance verification.
• Knowledgeable with payors including Managed Care, Commercial, Medicare, and Medicaid
• Preparing/Submitting appeals related to denied services
• Analyze payer denials by denial groupers and submit appeals.
• Contact patients and/or third party payers to resolve outstanding insurance balances and underpaid claims.
• Make necessary adjustments as required by plan reimbursement.
• Functions as a liaison between clinical departments and MSRDP management team.
• Completes special projects as assigned.
• Performs other duties as assigned.

Required Skills:

• 2 years experience in medical claims recovery and/or collections required
• Work requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment.
• Work requires good organizational, flexibility and analytical skills when resolving more complex unpaid claims.
• Work requires knowledge of billing and/or collections and regulations.
• Work requires understanding of the requirements of Medicaid, Medicare and insurance billing.
• Work requires a self-starter, with ability to work well as part of a team and independently.
• Work requires ability to communicate effectively with patients, insurance companies, clinical staff and management.
• Work requires ability to handle large volumes of work.
• Work requires ability to work in a fast paced, production oriented environment.
• Work requires excellent customer service skills.
• Work requires one to exhibit excellent work ethics and commitment to job responsibilities.
• Work requires one to possess a professional and courteous demeanor while being assertive and confident in their collection efforts.
• Work requires one to possess quick and accurate alpha/numeric data entry skills.
• Work requires presence of a positive image that reflects well on the organization.
• Work requires strong written and verbal communication skills.

Preferred Skills:

• Associate's Degree
• Work requires knowledge of CMS 1500, ICD-9, and CPT coding is preferred.

SGA is a technology and resource solutions provider driven to stand out. We are a women-owned business. Our mission: to solve big IT problems with a more personal, boutique approach. Each year, we match consultants like you to more than 1,000 engagements. When we say let's work better together, we mean it. You'll join a diverse team built on these core values: customer service, employee development, and quality and integrity in everything we do. Be yourself, love what you do and find your passion at work.