Denials Management Specialist

Prestige Staffing - Healthcare Jobs - Revenue Cycle Decatur, GA
JobID: 18520

Prestige Staffing is hiring for Denials Management Specialist. Need to be able to start right away for a Monday - Friday normal business hours.

JOB DESCRIPTION:

Researches and analyzes denial data and coordinates denial recovery responsibilities.

Follow denials worklist prioritization of invoices established by department policies and procedures with resolution.

Follow-up with patients to obtain additional information if applicable.

Researches, responds, and documents insurer and patient correspondence/inquiry
notes regarding coverage, benefits, and reimbursement on patient invoices.

Generate an appeal or re-considerations based on the dispute reason and contract terms specific to the payer. Identifies, analyzes, validates and researches frequent root causes of denials and develops corrective action plans for resolution of denials.

Performs retro reviews of denials, submits formal appeal letters and aggressively follows up with the payer in order to achieve optimal financial outcomes- Escalate exhausted efforts for resolution.

Communicate all denial trends to direct supervisor/manager in order to positively affect the volume of denials. Works with the payors to understand specific reasons for
denials and preventable measures available to prohibit future denials.

Responsible for maintaining or managing time effectively to complete assignments within established time frames, optimize collections, and meet performance goals. Demonstrates knowledge of all equipment and systems/technology necessary to
complete duties and responsibilities.

Timely and appropriate response to phone calls, internal questions, and correspondence from various departments, outside agencies, and payers regarding information pertaining the resolution of denied claims.

Organizes job functions and work assignments to effectively complete assignments within established time frames.

Researches denials included in EOBs for resolution and files appropriately. Works collaboratively with physician offices, Patient Access, Utilization Review, HIM and facility clinicians to correct deficiencies in a timely manner.

Meet and maintain established departmental performance metrics for production and quality.

MINIMUM QUALIFICATIONS:

  • High School diploma or equivalent.
  • Must have 4 years of healthcare related experience consisting of collections, 3rd party billing & collections, denials management, and technical appeals.
  • Knowledge of Medicare, Medicaid, and other contract payers (HMO, PPO) preferred. CPAR (Certified Patient Account Representative) and/or CPFC
  • (Certified Patient Financial Counselor) preferred for positions in clinic/hospital setting.
  • Typing skills with a minimum of 35 wpm and good communication skills.
  • Strong verbal and written communication skills.
  • Able to pass a criminal background check as well as a drug test to include tobacco usage.
  • Proficient in Microsoft Office, with heavy exposure to patient accounting software and applications.
  • Must be familiar with payer regulatory policies, medical terminology, and payment and adjustment calculations.
  • Work collaboratively with physician offices, Patient Access, Utilization Review, HIM and facility clinicians to correct deficiencies in a timely manner.
  • Demonstration of conflict resolution and mediation skills.

Apply today for immediate consideration.

*CB


 

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