Denial Management Specialist - Revo Health

Essential Functions

• Ensure professional communication with patients, clinic personnel, and outside vendors over the phone, via email or other written documentation and respond to all inquiries
• Maintain a working knowledge of health care plan requirements and health plan networks
• Verify and document insurance information as defined by current business practices
• Accurately post all payments received from patients, attorney offices and/or insurance companies
• Review Explanation of Benefits (EOB), research denials, rejections and/or excessive reductions
• Ensure appropriate forms are used when requesting adjustments, insurance transfers or other specific account changes
• Prepare, submit and ensure timely claim accuracy for all physician billing to third party insurance carriers either electronically or via hard copy
• Make outbound phone calls to patients or insurance companies as follow up to unpaid, denied or rejected billing claims and document according to current policy
• Take inbound calls from patients or insurance companies as follow up to unpaid, denied or rejected billing claims and document according to current policy
• Review and work any credit balances to determine if patient and/or insurance company refund is applicable
• Any and all other duties as assigned

  Education And Experience Requirements

  • High School diploma/GED or equivalent
  • Previous experience in a healthcare facility in relation to accounts receivable or billing practices preferred

  Benefits & Compensation

  • Actual starting pay will vary based on education, skills, and experience.
  • We offer a comprehensive benefits package including Medical (w/Maternity Bundle), Dental & Vision plans, Tuition Reimbursement, 401(k) with Profit Sharing, Employee Assistance Program, Lifetime Fitness Subsidy, Car Rental discounts, Home, Auto, & Pet insurance savings programs, and more.

  Working Conditions

  • Ability to sit for extended periods (up to 8 or more hours per day)
  • Frequent use of hands and fingers for typing, writing, and handling documents
  • Occasional standing, walking, bending, or reaching within the office environment
  • Ability to lift and carry office supplies or files weighing up to 20 pounds
  • Visual acuity to read electronic and paper documents
  • Auditory ability to participate in phone or video calls clearly
  • Manual dexterity to operate standard office equipment (e.g., computer, phone, printer)

  Setting Office Essential Requirements

  • Ability to comply with company policies, procedures, practices, and business ethics guidelines
  • Comply with all applicable laws and regulations, (e.g. HIPAA, Stark, OSHA, employment laws, etc.)
  • Demonstrate prompt and reliable attendance
  • Work at an efficient and productive pace, handle interruptions appropriately, and meet deadlines
  • Prioritize workload effectively
  • Communicate respectfully and professionally in face-to-face, phone and email interactions
  • Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions