Denial Management Specialist, IPN, Full Time

Description Performs work related to clinical denial management. The individual is responsible for managing claim denials related to authorization, medical record requests, and coordination of benefits. The individual will actively manage, maintain, and communicate denial/appeal activity to appropriate stakeholders. The individual works independently to plan and organize activities that directly impact reimbursement. This role is key to securing reimbursement and minimizing organizational write-offs. The Denial Specialist conducts comprehensive reviews of the claim denial and account to make determinations of what action to be taken to obtain reimbursement. Responsibilities Reviews denied claims to ensure coding was appropriate and make corrections as needed. Ensures billing and coding are correct prior to sending appeals or reconsiderations to payers. Investigates claims with no payer response to ensure claim was received by payer. Has a strong understanding of payer websites and appeal processes for all payers, including commercial and government payers such as VA, Tricare, Medicare, Medicaid, and Medicare/Medicaid Advantage plans. Reviews and identifies trends or patterns of denials to prevent errors. Assists and confers with coding concerning any coding problems. Uses strong research and analytical skills; must be a critical thinker. Stays current with compliance and changing regulatory guidelines. Demonstrates knowledge of coding and medical terminology to determine if a claim was denied appropriately and if an appeal is warranted. Supports and participates in process and quality improvement initiatives. Achieves goals set forth by management regarding error‑free work, transactions, processes, and compliance requirements. Proactively resolves issues and responds promptly to questions and concerns. Clearly documents issues and resolutions. Delivers timely reports to the management team and initiates and communicates resolution of issues, such as payer denial trends due to coding and billing errors. Manages follow‑up work queues. Identifies missing payments, overpayments, and analyzes credits on accounts. Tracks and follows up on information requests. Works with the IPN Revenue Cycle Team to facilitate information and resolve charge questions. Other duties as assigned. Requirements High School Diploma or GED required. Minimum of 3 years’ experience in a medical billing department with strong AR account follow‑up, appeals, and coding knowledge is preferred. Demonstrated knowledge of and experience in professional medical billing, claim(s) processing, follow‑up and appeals is a must. Extensive knowledge of email, search engine, Internet; ability to effectively use payer websites; knowledge and use of Microsoft Products: Outlook, Word, and Excel. Strong reasoning, critical thinking, analytical and mathematical skills. Ability to work independently, flexibly shifting from big picture to detailed tasks, with high productivity, and regularly execute deadlines. CPC certification is preferred but not required. Cerner EHR working knowledge and experience is a strong preference but not required. Essential Physical Requirements Must possess full range of body motion to pass basic FIT test for position to include walking, kneeling, standing, pushing, pulling, bending, stooping, reaching and sitting for extended periods of time. Must be able to lift and carry up to 25 pounds. Manual dexterity needed for using a calculator and computer keyboard. Job Type Full‑time #J-18808-Ljbffr Iredell Health System