Denial Management Representative - Remote

About the role

This organization operates within the healthcare revenue cycle management sector. It addresses the challenge of efficiently managing patient accounts from creation through payment, focusing on insurance collections and claim resolution. The company supports effective revenue processes by emphasizing adaptability and teamwork in resolving patient financial accounts.

The Denial Management Representative is responsible for managing and resolving patient accounts to ensure timely payment. This role contributes to the organization''s financial health by following up on claim submissions, reviewing remittances, and pursuing disputed balances with both government and commercial payors. The position requires collaboration with management and team members to address account issues and improve collections.

Responsibilities

• Research patient accounts using internal applications and external resources.
• Contact third-party payors and patients via phone, email, or online to resolve account balances.
• Update plan IDs, adjust patient and payor information, and document account actions.
• Identify payor issues, trends, and contractual discrepancies; request rebills or corrections as needed.
• Open dispute records for further research when accounts cannot be resolved promptly.
• Maintain current account inventory without backlog while meeting productivity and quality standards.
• Assist with special projects and document findings.
• Monitor payor delays and trends; escalate aged accounts to supervisors.
• Participate in meetings and training sessions to enhance job knowledge.
• Ensure compliance with applicable State and Federal laws for managed care and third-party payors.

Requirements

• Thorough understanding of the revenue cycle from patient access to collections.
• Intermediate Microsoft Office skills.
• Ability to quickly learn hospital systems such as ACE, VI Web, IMaCS, and OnDemand.
• Clear and professional communication skills, both oral and written.
• Strong interpersonal, analytical, and critical thinking abilities.
• Knowledge of Commercial, Managed Care, Medicare, and Medicaid collections.
• Familiarity with managed care contract language and federal/state regulations.
• Understanding of terms like HMO, PPO, IPA, Capitation, and processing claims.
• Intermediate knowledge of EOB and hospital billing forms (UB04, HCFA 1500).
• Problem-solving skills and ability to prioritize and complete assigned tasks.
• High school diploma or equivalent; some college coursework in business or accounting preferred.
• 1-4 years of medical claims or hospital collections experience.
• Typing speed of at least 45 words per minute.