Denial Management Specialist
Essential Job Functions
· Investigates insurance denials to identify action necessary to resolve the claim– including calls to payor use of multiple computer systems, e.g., Epic, insurance portal, clearing house, etc.
· Able to analyze EOBs at a claim level
· Corrects claims based on denials and rebills using payor approved processes
· Determines need for payor appeal of a claim and sends appeals via payor portal or payor appropriate appeal letters. Monitors appeals for resolution
· Adjusts accounts appropriately, using correct denial codes
· Recognizes when additional assistance is needed to resolve denials and escalates appropriately
· Spots trends and reports them to management
· Works a minimum of 45 accounts per day with 95% accuracy
· Communicates effectively both verbally and in writing
· Details all activities and findings in accordance with established policies and procedures.
· Performs special projects or other duties as assigned
· Maintains strictest confidentiality, adhering to all employer and government privacy standards, e.g., 42 CFR part 2 and HIPAA
· Maintains current knowledge of internal, industry and government regulations as applicable to denial management
Experience REQUIRED:
· High school graduate or equivalent
· 2 years previous experience in medical revenue cycle
· Minimum 1 year EPIC enterprise experience
· Familiarity with Excel
· Demonstrated problem solving ability
· Able to work effectively in a remote setting
· Strong organizational skills
Experience Preferred:
· 2 years previous experience in medical denial management
· Minimum of 1-year recent Epic experience with the Resolute/Billing module
· Knowledge and experience in working with health care insurance portals
· A good understanding of CPT, modifiers, HCPC, ICD-10 and medical terminology
· Working knowledge of Medicare, Medicaid and Commercial payor fee schedules and reimbursement documentation, e.g., payor rules, non-payable codes, etc.
· Good computer/tech knowledge (saving and locating files in OneDrive, Outlook, excel)
Skills:
· Ability to effectively prioritize and execute tasks
· Ability to grasp and apply information quickly and accurately
· Ability to make decisions based on available information and within scope of their authority
· Have excellent customer service skills and telephone interaction skills
· Excellent keyboarding skills, typing and 10 key
· Proficiency with MS Word and Excel
· Good work ethic