Medical Billing Professional Cardiology Denial Specialist

Responsibilities

• Review all denied claims, correct them in the system and send corrected appealed claims as written correspondence, fax, or via electronic submission.
• Identify and analyze denials and enact corrective measures as needed to effectively communicate and resolve payer errors.
• Continually maintain knowledge of payer specific updates via payer’s listservs, provider updates, webinars, meetings, and websites.
• Understand and maintain compliance with HIPAA guidelines when handling patient information.
• Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials.
• Report to supervisor identification of denial trends resulting in revenue delays.
• Answers telephone inquiries from 3rd party payers; refer all unusual requests to supervisor.
• Retrieve appropriate medical records documentation based on third party requests.
• Refer all accounts to supervisor for additional review if the account cannot be resolved according to normal procedures.
• Work with management to improve processes, increase accuracy, create efficiencies, and achieve the overall goals of the department.

Qualifications

• BASIC KNOWLEDGE:
• Equivalent to a high school graduate.
• Knowledge of 3rd party billing to include ICD, CPT, HCPCS, and 1500 claim forms.
• Demonstrated skills in critical thinking, diplomacy, and relationship-building.
• Highly developed communication skills, successfully demonstrated in effectively working with a wide variety of people in both individual and team settings.
• Demonstrated problem-solving and inductive reasoning skills which manifest themselves in creative solutions for operational inefficiencies.
• EXPERIENCE:
• One to three years of relevant experience in professional billing preferred.
• Experience with Epic a plus.
• INDEPENDENT ACTION:
• Incumbent generally establishes own work plan based on pre-determined priorities and standard procedures to ensure timely completion of assigned work. Problems needing clarification are reviewed with supervisor prior to taking action.
• SUPERVISORY RESPONSIBILITY:
• None

Pay Range

$19.97-$32.96

Location

Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903

Work Type

Monday-Friday 7:30-4

Work Shift

Day

Daily Hours

8 hours

Driving Required

No