Denials Management Specialist

About the role

The Denials Management Specialist will validate dispute reasons, escalate payment variance trends or issues to management, and generate appeals for denied or underpaid claims. They will resolve complex and aged accounts, including researching payer and governmental regulations and billing rules, reviewing medical records, analyzing managed care contracts, and reviewing the chargemaster.

Responsibilities

• Validate dispute reasons and escalate payment variance trends or issues to management
• Generate appeals for denied or underpaid claims
• Resolve complex and aged accounts
• Research payer and governmental regulations and billing rules
• Review medical records and analyze managed care contracts and chargemaster
• Provide feedback and recommendations to Managed Care, Revenue Integrity, and leadership teams regarding trends or issues
• Escalate as needed through payer provider advocates and contracting teams
• Collaborate with other areas to resolve or minimize ongoing denials and underpayments
• Accurately and thoroughly document all pertinent collection activity performed

Requirements

• High school diploma or equivalent
• Associates degree or higher preferred
• At least 3 years’ experience in a hospital business or medical office environment performing billing and/or collections
• CRCR or CPAR certification preferred

Skills

• Excellent knowledge of MS Office and familiarity with relevant computer software
• Strong team leadership skills, strong organization, interpersonal, and customer relations skills
• Ability to meet strict deadlines
• Strong analytical and problem-solving ability, and excellent organizational skills
• Ability to work both independently and in a team environment
• Knowledge of ICD-9, ICD-10, and CPT coding

Benefits

Baptist Health offers competitive benefits including health insurance, retirement plans, and paid time off.

Pay

Compensation is commensurate with experience.

Schedule

This position is available on a First Shift schedule.