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Job Discription
Under the direction of the Billing Manager, the Denial Management Specialist is responsible for monitoring denials, appeals, and resolutions from participating insurance carriers and working proactively to collect payments from insurance carriers.
Duties Include:
Duties Include:
- Researching and analyzing denial data and coordinating denial recovery
- Submitting detailed appeals to payers based on review of records in accordance with payer requirements
- Resolving frequent root causes of denials and developing action plans for resolution of denials
- Researching rejections included in EOBs and finding resolutions to rejections
- Reviewing clinical documentation
- Identifying claims issues with providers to insure accurate billing
- Following up with providers to improve documentation
- Making management aware of any issues or changes with the billing system, insurance carriers, and networks
Customer Service Standards:
- Engages co-workers in a positive manner
- Utilizes professional telephone and email etiquette
- Communicates professionally with external customers and payers
- Assists our patients in a kind and proactive manner
- Remains calm under pressure and deal effectively with difficult people
JOB REQUIREMENTS
- Minimum High School diploma or equivalent, Associates degree preferred
- Minimum Two years recent experience working with insurance carriers, working with denials and appeals
- Experience with medical and insurance terminology, CPT, ICD coding
