Specialist-Denials Management

Job Requirements

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
  
  

• 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
  
  

• N/A
  
  

• Associates or Bachelors degree in a Healthcare related field.
  
  

• Focused denials and appeals management experience.
  
  

• CPC and/or CPC-H certification
  
  

• 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.