Job Requirements
Position Summary
The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager.
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
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Must have a good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes.
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Be familiar with multiple payer requirements for claims processing
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Solid skills with Microsoft office with a focus on Excel and Word.
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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
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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.
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Initiate/manage all insurance appeals in a timely manner
- Manage outstanding AR related to denials.
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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.
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Manage correspondences and any ADR requests as defined within department workflow procedure to ensure timeless and accuracy of response.
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Complete special projects as assigned by Supervisor/Manager
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Prepare/attend AR denial meetings as required.
