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 Graduate with some College
Experience
- 5+ years’ experience in medical billing/collections setting with experience with denials, appeals, insurance collections and related follow-up.
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Must have extensive knowledge of ICD9 and CPT-4 coding and modifiers usage.
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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 Analytical skills.
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Good Communication Skills
License/Registration/Certifications
Preferred Requirements
Preferred Education
Preferred Experience
- Focused denials and appeals management experience.
- Possess an in-depth working knowledge and experience with all types of insurance billing guidelines: Commercial, Medicare Part A and B, Medicaid, Managed Care plans etc.
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Team lead or supervisory experience.
Preferred License/Registration/Certifications
- If in Professional Billing Services: CPC certification
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If in Hospital Billing Services: CRCA or CPC-H certification
Core Job Responsibilities
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Responsible to review and resolve all daily claim scrubbers edits based on coding/billing guidelines.
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Research and resolve all outstanding denials within work cue and complete all necessary follow up within a timely and accurate manner
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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
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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
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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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Function as a denials team resource to other associates within the department
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Ability to lead a team meeting and teach specific task and procedures to other associates.
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Must be cross-trained and functional in all areas within the department as it relates to A/R and denials.
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Ability to work closely with multiple department leaders and/or staff to improve revenue integrity.
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Complete special projects as assigned by Supervisor/Manager
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Prepare/attend AR denial meetings as required.
