Specialist-Denials Management (Remote)

Position Summary

The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager.

Minimum Requirements

• Education: High School Diploma or equivalency
• Experience: 4 years' experience in medical billing, setting with exposure to denials, appeals, insurance collections and related follow-up.
• Must have good knowledge of ICD9 and CPT-4 coding
• Must have a good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes.
• Be familiar with multiple payer requirements for claims processing
• Solid skills with Microsoft office with a focus on Excel and Word.
• Good Communication Skills
• Only Applicants from the following states: Alabama, Arizona, Connecticut, Delaware, Florida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, North Carolina, Pennsylvania, Rhode Island, South Carolina, Virginia, West Virginia, Wisconsin.

Preferred Requirements

• Preferred Education: Associates or Bachelor's degree in a Healthcare related field.
• Preferred Experience: Focused denials and appeals management experience.
• Preferred License/Registration/Certifications: CPC and/or CPC-H certification

Core Job Responsibilities

• Research and resolve all outstanding denials within workque and complete all necessary follow up within a timely and accurate manner
• Identify all denial trends and provide education of steps to prevent future avoidable denials.
• Initiate/manage all insurance appeals in a timely manner
• Manage outstanding AR related to denials.
• Communicate all denial trends and denial increases to direct supervisor/manager in order to positively affect the volume of denials
• Organize the workflow to ensure that denials are worked according to departmental policy and standards.
• Manage correspondences and any ADR requests as defined within department workflow procedure to ensure timeless and accuracy of response.
• Complete special projects as assigned by Supervisor/Manager
• Prepare/attend AR denial meetings as required.