Denials Management Specialist

Job Summary

Maximizes cash collections and resolution of aged accounts through informed, consistent follow up activities. Responsible for the timely billing and follow-up of assigned accounts and for ensuring all accounts are paid correctly according to insurance contract terms. Consistently identifies account deficiencies that require subsequent follow-up and ensures all deficiencies are resolved. Escalates issues to supervisor and tracks data for trending and feedback purposes.

Responsibilities

• Analyzes and researches denials and follows-up with the appropriate payor, practice, and/or patient to resolve denial.
• Provides missing or additional information if necessary, to expedite the resolution of the denied claim.
• Performs all appeals and denial recovery procedures needed to appropriately and accurately resolve denied claims.
• Processes required adjustments to accounts, including charges credits, payment transfers, policy adjustments, etc. in a timely and accurate manner.
• Maintains a thorough knowledge and understanding of all assigned payor contracts and requirements.
• Performs research to ensure current policies, applicable coding and insurance guidelines, regulations and laws are being followed.
• Evaluates processes and procedures and makes practical suggestions/recommendations for improvement or compliance.
• Prepares accurate and timely reports of trends and problems as they are identified. Communicates such trends to management in a timely manner.
• Consistently identifies account deficiencies that require follow up and ensures that appropriate actions have occurred.
• Completes work accurately and timely with appropriate documentation.
• Sets and achieves department requirements, maximizes revenue collection, and achieves leading practice levels of performance.
• Keeps Supervisor/Manager informed of any problems or issues.
• Completes timely billing and follow-up of assigned inventory for the purpose of expediting timely account resolution.
• Updates patient accounts to reflect any changes made to relevant information.
• Contacts payers, employers, customers, attorneys, etc. in an effort to expedite the payment of accounts.
• Processes and follows special accounts for resolution.
• Affords assistance with any special projects as assigned.

Credentials/Requirements

• Education or Equivalent Experience: Associate of Arts or Science
• H.S. Diploma/GED (Required)