| Location | Shelby Township, MI |
Position Summary:
The Denials Management Specialist is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The specialist will work independently while managing their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered.
Essential Functions and Responsibilities as Assigned:
Monitors denial work queues and reports in accordance with assignments from direct supervisor. Maintains required levels of productivity while managing tasks in work queues to ensure timeliness of follow-up and appeals.
Tracks and investigates denial trends/ root cause.
Assists with claim audits as necessary.
Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.
Obtain retro authorizations and submit to payers for reimbursement.
Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.
As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.
Works independently with other departments to resolve A/R and payer issues.
Participates in departmental and team meetings involving discussion of A/R processes and trends.
Knowledge of payer edits, rejections, rules, and how to appropriately respond to each to resolution.
Qualifications:
Required:
OR
Additional Information