Medical-Denial Management Specialist

Medical-Denial Management Specialist

Established in 1970, Orthopedic Associates of Hartford, P.C., is one of the areas largest orthopedic practices with office locations throughout greater Hartford.

Our growing practice is currently seeking a Medical-Denial Management Specialist (onsite 1-2 days remote) with Epic experience to join our Billing & Collections team in our Farmington, Connecticut business office. The Medical-Denial Management Specialist analyzes and resolves healthcare insurance claim denials by investigating reasons, preparing appeals, communicating with payers, and collaborating with billing staff to ensure proper reimbursement and prevent future denials. This role requires strong analytical, communication, and problem-solving skills, along with a thorough understanding of insurance policies, medical terminology, and healthcare billing procedures. The successful candidate will be a team player who is dependable, organized, enthusiastic, and detail oriented. Important to this position is the ability to build relationships with our customers, both internal and external, to promote feedback and timely resolution of outstanding claims. Proficiency in many computer software programs is required as well as an understanding of insurance payment methodologies to insure accurate reimbursement. A positive "can-do" attitude is a must.

Responsibilities include:

• Following policies and procedures, timely and accurate follow up on claims for the resolution of outstanding balances.
• Participates in the collection and documentation of claims processing rules.
• Generates both electronic and hard copy claims for submission.
• Obtains supporting documentation and other information required to insure acceptance of claim.
• Interacts and communicates effectively with interdepartmental units when necessary.
• Documents account information pertaining to claims submission and resolution.
• Enters demographic data into the billing & collections software.
• Assumes other duties and responsibilities as needed.

Requirements:

• Two years recent experience in medical collections and/or medical billing with result oriented debt collections skills.
• Familiarity with ICD-10 coding and Federal HIPAA regulations.
• Computer skills, including Epic, electronic billing, Microsoft Word, Outlook and Excel.
• Excellent written and verbal communication skills with a professional and courteous telephone manner.
• High School diploma.