Job Requirements
Position Summary
The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager.
Only Applicants from the following states: Alabama, Arizona, Connecticut, Delaware, Florida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, North Carolina, Pennsylvania, Rhode Island, South Carolina, Virginia, West Virginia, Wisconsin.
Minimum Requirements
Education
-
High School Diploma or equivalency
Experience
-
4 years' experience in medical billing, setting with exposure to denials, appeals, insurance collections and related follow-up.
-
Must have good knowledge of ICD9 and CPT-4 coding
-
Must have a good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes.
-
Be familiar with multiple payer requirements for claims processing
-
Solid skills with Microsoft office with a focus on Excel and Word.
-
Good Communication Skills
License/Registration/Certifications
Preferred Requirements
Preferred Education
-
Associates or Bachelor's degree in a Healthcare related field.
Preferred Experience
-
Focused denials and appeals management experience.
Preferred License/Registration/Certifications
-
CPC and/or CPC-H certification
Core Job Responsibilities
-
Research and resolve all outstanding denials within workque and complete all necessary follow up within a timely and accurate manner
-
Identify all denial trends and provide education of steps to prevent future avoidable denials.
-
Initiate/manage all insurance appeals in a timely manner
-
Manage outstanding AR related to denials.
-
Communicate all denial trends and denial increases to direct supervisor/manager in order to positively affect the volume of denials
-
Organize the workflow to ensure that denials are worked according to departmental policy and standards.
-
Manage correspondences and any ADR requests as defined within department workflow procedure to ensure timeless and accuracy of response.
-
Complete special projects as assigned by Supervisor/Manager
-
Prepare/attend AR denial meetings as required.
