Description:
The Denial Specialist is responsible for all duties involved with complex denials, appeals, and resolutions from commercial, managed care and government payors. Specialists are responsible for telephoning, sending letters to and emailing insurance companies and/or patients to resolve unpaid and underpaid account balances, proactively escalating necessary issues to supervisors, and reaching out to necessary external departments in a timely manner.
- $55,000+ plus fully-paid Medical Insurance.
- It is a hybrid role- 2 days from home and 3 in the office.
- The employee is allowed to select their remote days.
- Company is located in the heart of Buckhead
Job Responsibilities:
- Identify, review and resolve denials manually and/or electronically by using the designated information technology on a timely basis. Reviews EOBs and remittance reports for denials, errors and resubmits claims with correct data
- Confirm denial reasons.
- Generate an appeal based on the dispute reason and contract terms specific to the payors
- Follow specific payor guidelines and medical policies for appeal submissions
- Escalate exhausted appeal efforts to the appropriate parties
- Research and analyze denial data and coordinate denial recovery responsibilities
- Review patient medical records and utilize regulatory and payor knowledge to Identify, analyze, and research frequent root causes of denials and develops corrective action plans for resolution
- Document all account activity on each account through descriptive account notes in employer’s system
- Request documentation from clients as required to resolve accounts
- Adhere to all policies and procedures
Qualifications:
Minimum Education, Experience and Licensure Required:
- High School Diploma.
- Three (3) years job related experience in hospital Business Office or Central Business Office (CBO).
- Working experience with medical terminology and claim denials/underpayments
Skills, Knowledge and Abilities:
- Proficiency in Microsoft Office products (e.g. Word and Excel)
- Demonstrates understanding of medical terminology
- Knowledge of CPT, HCPCS, ICD-10 coding procedures
- Good communications skills, both written and oral
- Knowledge of medical billing and collection practices
- In-depth working knowledge of Commercial, Managed Care and Government insurance carriers
