Denial Management Specialist

The Denials Management Specialist will be responsible for denials.

Essential Functions:
1.Review and resolve insurance claim denials.
2.Submit timely, well-supported appeals for follow-up.
3.Identify denial trends and collaborate with teams to prevent recurring issues.
4.Communicate with payers regarding coverage, authorization and claim status.
5.Document all actions and maintain accurate records in billing system.
6.Process and respond to attorney requests for patient billing records.
7.Ensure denial handling aligns with payer contract terms and identify any reimbursement discrepancies for correction.
8.Collaborate with revenue cycle teams.
9.Complete other duties as assigned to support department operations.

The above statements are intended to describe the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.

Skills Abilities:
1.Ability to communicate clearly and effectively with all levels
2.Ability to complete competency CPR and First Aid
3.Ability to prioritize and complete multiple tasks simultaneously.
4.Effective oral and written communication, analytical and problem solving skills.
5.Experience in hospital billing or denial management preferred.
6.Ability to interpret EOBs and knowledge of payer rules, medical terminology and basic coding concepts.
7.High attention to detail.

Working Conditions:
1.High level of concentration.
2.Fast-paced, deadline-driven environment.
3.Possible exposure to inside environmental conditions.
4.Exposure to confidential financial and medical information requiring strict adherence to HIPAA and internal policies.

Physical Demands:
1.Requires standing, sitting or walking for up to 12 hours or longer per workday.
2.The ability to lift up to 50 lbs.
3.Prolonged periods of sitting
4.Extensive computer and keyboard use.
5.Visual computer focus for long durations.

Qualifications:
1.High school diploma or equivalent.
2.Ability to meet productivity and quality standards.
3.Ability to work independently and as part of a team.
4.Strong follow-through and persistence when working with payers.
5.Ability to collaborate with billing, coding, registration, utilization review and clinical teams.
6.Understanding of HIPAA and patient privacy regulations.

Preferred Qualifications:
1.2+ years of experience
2.Familiarity with hospital billing systems