Denial Management Specialist

Overview: The Denial Management Specialist works a part of a central billing office team to process insurance payments and ensure that denied claims are worked in a timely manner to ensure payment. The Denial Management Specialist will work closely with the Denial Management Supervisor to accurately enter insurance payments as well as working denied and/or rejected claims.Responsibilities: Essential Duties (at least 5 that are non-negotiable duties and are absolutely pertinent to successfully completing the job without accommodations): Primary Accountabilities:

• Helps ensure timely and complete follow up on unpaid or denied claims.
• Help ensure complete and accurate posting of all payer payments.
• Timely submit issues that caused unpaid claims are resubmitted in a timely fashion based upon industry standards.
• Review complex denials and refund requests, dispute or appeal as necessary
• Contact vendors regarding denials or benefit changes.
• Complete complex tasks relating to insurance verification, resolution of aging accounts, resolution of patient complaints, and client customer service.
• Research, identify and facilitate resolution to complex problems with overdue or unpaid accounts.
• Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization.
• Answer and resolve telephone inquiries from internal and external sources.
• Perform other duties as assigned.

Knowledge/Skills/Abilities:

• High level of skill at building relationships and providing excellent customer service.
• Ability to utilize computers for data entry, research and information retrieval.
• Strong attention to detail and accuracy.
• Ability to multi-task.
• Excellent verbal and written communication skills.
• Ability to understand complex insurance issues, including assigning correct payer, adjustments and refunds to accounts.
• Must be able to effectively monitor steps in claims processing operations.
• Must have excellent computer, time management, organizational, data processing and analytical skills with proficiency in Excel and Microsoft Office Suite as well as medical practice management software and electronic medical records.
• Must have highly developed problem-solving skills.
• Experience with EPIC PM/EMR system is preferred but not required.
• Executes excellent customer service and professionalism when interacting with staff, payers, patients and families to ensure all are treated with kindness and respect.
• Through leadership and by example, ensures that services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements.
• Acts in accordance with CommUnityCare’s mission and values, while serving as a role model for ethical behavior.
• Promptly identify issues and reports them to their direct supervisor.
• Maintain regular and predictable attendance.

Qualifications: MINIMUM EDUCATION: High school diploma or GED
PREFERRED EDUCATION: N/A
MINIMUM EXPERIENCE:

• 2 years working in a medical billing role.
• 2 years medical billing and collections experience.
• Advanced knowledge of medical terminology, ICD 10, CPT, HCPCS coding and HIPAA requirements.
• Extensive knowledge and experience with commercial, government and state billing and reimbursement procedures.
• Demonstrated proficiency in the use of computer and commonly used software, including electronic medical records (EMR).

PREFERRED EXPERIENCE:

• Experience working with FQHC billing and revenue cycle activities