Denials Management Specialist

Position Summary:

The Denials Management Specialist is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The specialist will work independently while managing their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered.

Essential Functions and Responsibilities as Assigned:

1. Monitors denial work queues and reports in accordance with assignments from direct supervisor. Maintains required levels of productivity while managing tasks in work queues to ensure timeliness of follow-up and appeals.

2. Tracks and investigates denial trends/ root cause.

3. Assists with claim audits as necessary.

4. Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.

5. Obtain retro authorizations and submit to payers for reimbursement.

6. Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.

7. As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.

8. Works independently with other departments to resolve A/R and payer issues.

9. Participates in departmental and team meetings involving discussion of A/R processes and trends.

10. Knowledge of payer edits, rejections, rules, and how to appropriately respond to each to resolution.

Qualifications:

Required:

• High School Diploma or GED
• 7 years experience in Patient Accounting or Patient Access experience

OR

• Associates Degree with 3 years of Patient Accounting or Patient Access experience

Additional Information

• Schedule: Full-time
• Requisition ID: 26002762
• Daily Work Times: 8am - 4:30pm
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No