Denial Management Specialist / Remote

Responsibilities

• Reviews and researches claims in which a denial payment has been received from the payer in a timely manner
• Manages and Develops necessary department and executive level reporting
• Identifies the root cause of the denial and addresses the denial issue with the appropriate department (Billing, Clinical Documentation, Coding)
• Utilizes all appreciated systems to effectively research claims and complete steps to submit information necessary to process or appeal claims
• Investigates and ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims
• Completes and requests adjustments to a claim, as appropriate, based on the dollar threshold of the adjustment
• Reviews, works and reports all claims that have aged more than the specified grace period stipulated in policies and/or contacts
• Organizes work/ resources to accomplish objectives and meet deadlines
• Demonstrates problem-solving skills related to denial analysis
• Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively to obtain necessary information to address denial management issues
• Maintains compliance with established corporate and departmental policies and procedures
• Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, customers and co-workers
• Identify all denial trends and provide education of steps to prevent future avoidable denials
• Initiate/Manage all appeals in a timely manner
• Organize the work flow to ensure that denials are worked according to timely filing deadlines and conditions of payment
• Communicate all denial trends and denial increases to direct supervisor in order to positively affect the volume of denials
• Complete special projects as assigned by Supervisor/Manager

Qualifications

• A High School Diploma required; Bachelors Degree preferred
• At least three to five years of experience in revenue cycle and/or billing experience
• Denial Management and/or electronic billing experience are preferred
• Highly motivated individual with attention to detail in fast paced environment
• Good internal/external customer communication skills required
• Able to work independently and collaboratively as a team player
• Systems include Excel, Power Point, Zirmed billing system