Denial Management Clerk

Denials Management Clerk

The Denials Management Clerk supports the Denial Management Department in the denials process for client hospitals. In this role, the Denials Management Clerk gathers and disseminates information from hospitals, physicians, and insurance companies pertaining to referred claims denied.

Duties and Responsibilities

• Manually enter new cases referred from clients into database as needed
• Update database with information gathered from correspondence
• Set follow-up reminders in Outlook
• Review daily reports for updates and due dates
• Send updates on document requests received throughout the day
• Send documentation to insurance carriers via portals, email, mail or fax
• Work within gAIge to update daily tasks assigned on work queue
• Log into all hospital applications and insurance carrier portals every two weeks
• Submit appeals, correspondence, and medical records via carrier portals
• Scan and label correspondence received daily via mail, email, or fax
• Navigate hospital applications to obtain balances, charges, and UB documents
• Download reports from portals for updates
• Assist with the outgoing mail process
• Scan documents into database
• Assist patients with questions related to statuses of their accounts
• Use, protect, and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

• High School Diploma or equivalent
• Must be courteous and possess a strong work ethic, with the ability to work in a fast-paced environment
• Proficient in Microsoft Office applications
• Have strong organization and time-management skills
• Ability to learn proprietary databases and systems, gAIge, Epic, Eagle, Epremis, Medi-Tech
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required

Working Conditions

• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.