Accounts Receivable, Accounts Receivable Management, Claims Processing, Communication Skills, Credit and Collections, Current Procedural Terminology (CPT), Denials Management, Healthcare, ICD-9, Insurance, Insurance Documentation, Medical Billing, Medicine, Microsoft Excel, Microsoft Office, Microsoft Word, Order Management, Patient Care Denials, Time Management, Training/Teaching, Trend Analysis
Job Requirements
Position Summary
The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager.
- Only Applicants from the following states: Alabama, Arizona, Connecticut, Delaware, Florida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, North Carolina, Pennsylvania, Rhode Island, South Carolina, Virginia, West Virginia, Wisconsin.
Minimum Requirements
Education
- High School Diploma or equivalency
Experience
- 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
License/Registration/Certifications
Preferred Requirements
Preferred Education
- Associates or Bachelor''s degree in a Healthcare related field.
Preferred Experience
- Focused denials and appeals management experience.
Preferred License/Registration/Certifications
- CPC and/or CPC-H certification
Core Job Responsibilities
- 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.
S
Spartanburg Regional Healthcare System