Denials Management Specialist

About Us

McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 20,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio.

Denials Management Specialist

• Maintains required levels of productivity while managing tasks in work queues to ensure timeliness of follow-up and appeals.
• Tracks and investigates denial trends/root cause.
• Affords assistance with claim audits as necessary.
• Notifies management of any issues or changes in the billing system, insurance carriers, and/or network.
• Obtains retro authorizations and submits to payers for reimbursement.
• Writes non-clinical appeals with proficiency in timely and successful submissions.
• Participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.
• Works independently with other departments to resolve A/R and payer issues.
• Participates in departmental and team meetings involving discussion of A/R processes and trends.
• Knowledge of payer edits, rejections, rules, and appropriate responses to each for resolution.

Qualifications

• High School Diploma or GED and 7 years experience in Patient Accounting or Patient Access experience
• Associates Degree and 3 years of Patient Accounting or Patient Access experience