About this role
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 • Prepare/attend AR denial meetings as required.