Medical Billing Professional Denial Specialist

About the role

Under general supervision of the Follow-up Supervisor, performs all duties necessary to follow up on outstanding claims and correct all denied claims for a large physician multi-specialty practice. Employees are expected to role model the organization's values of Compassion, Accountability, Respect, and Excellence, and demonstrate core Success Factors: Instill Trust and Value Differences, Patient and Community Focus, and Collaborate.

Responsibilities

• Review all denied claims, correct them in the system, and send corrected/appealed claims via written correspondence, fax, or electronic submission.
• Identify and analyze denials and enact corrective measures to resolve payer errors.
• Maintain knowledge of payer-specific updates via 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 claims resulting in adjudication delays or denials.
• Report denial trends resulting in revenue delays to supervisor.
• Answer telephone inquiries from third-party payers; refer unusual requests to supervisor.
• Retrieve appropriate medical records documentation based on third-party requests.
• Refer accounts to supervisor for additional review if unresolved according to normal procedures.
• Work with management to improve processes, increase accuracy, create efficiencies, and achieve department goals.
• Maintain quality assurance, safety, environmental, and infection control in accordance with established policies and procedures.
• Perform other related duties as required.

Requirements

• Equivalent to a high school graduate.
• Knowledge of third-party billing, including ICD, CPT, HCPCS, and 1500 claim forms.
• Demonstrated skills in critical thinking, diplomacy, and relationship-building.
• Highly developed communication skills for working with a wide variety of people in individual and team settings.
• Demonstrated problem-solving and inductive reasoning skills for operational inefficiencies.
• One to three years of relevant experience in professional billing preferred.
• Experience with Epic is a plus.

Incumbent generally establishes their own work plan based on priorities and standard procedures, reviewing problems with the supervisor as needed.

Pay

$19.97–$32.96 per hour.

Schedule

• Monday–Friday, 7:30 AM–4:00 PM.
• 8-hour daily shifts.

Location: Corporate Headquarters, 15 LaSalle Square, Providence, Rhode Island 02903.