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Skills
Accounts Receivableunmatched
Accounts Receivable Managementunmatched
Billingunmatched
Certified Professional Coder (CPC)unmatched
Claims Processingunmatched
Communication Skillsunmatched
Credit and Collectionsunmatched
Current Procedural Terminology (CPT)unmatched
Denials Managementunmatched
Health Planunmatched
High School Diplomaunmatched
ICD-9unmatched
Insuranceunmatched
Insurance Documentationunmatched
Leadershipunmatched
Managed Careunmatched
Medicaidunmatched
Medical Billingunmatched
Medicareunmatched
Microsoft Excelunmatched
Microsoft Officeunmatched
Microsoft Wordunmatched
Order Managementunmatched
Patient Care Denialsunmatched
People Managementunmatched
Professional Servicesunmatched
Team Lead/Managerunmatched
Time Managementunmatched
Training/Teachingunmatched
Trend Analysisunmatched
Description
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.
Must have extensive knowledge of ICD9 and CPT-4 coding and modifiers usage.
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 Analytical skills.
Good Communication Skills
License/Registration/Certifications
N/A
Preferred Requirements
Preferred Education
N/A
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.
Team lead or supervisory experience.
Preferred License/Registration/Certifications
If in Professional Billing Services: CPC certification
If in Hospital Billing Services: CRCA or CPC-H certification
Core Job Responsibilities
Responsible to review and resolve all daily claim scrubbers edits based on coding/billing guidelines.
Research and resolve all outstanding denials within work cue 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.
Function as a denials team resource to other associates within the department
Ability to lead a team meeting and teach specific task and procedures to other associates.
Must be cross-trained and functional in all areas within the department as it relates to A/R and denials.
Ability to work closely with multiple department leaders and/or staff to improve revenue integrity.
Complete special projects as assigned by Supervisor/Manager