Specialist-Sr Denials Management

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

License/Registration/Certifications

• N/A

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.