Denials Management Specialist (40 hours/week)

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Summary

1.0 FTE, Mon-Fri, no weekends or holidays and flexible schedule.

Job Description

POSITION SUMMARY: Maximizes cash collections and resolution of aged accounts through informed, consistent follow up activities. Responsible for the timely billing and follow-up of assigned accounts and for ensuring all accounts are paid correctly according to insurance contract terms.  Consistently identifies account deficiencies that require subsequent follow-up and ensures all deficiencies are resolved.  Escalates issues to supervisor and tracks data for trending and feedback purposes.  Works within a structured team setting to ensure team goals and well as individual goals are met in an appropriate manner.

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

• Analyzes and researches denials and follows-up with the appropriate payor, practice, and/or patient to resolve denial. Provides missing or additional information if necessary, to expedite the resolution of the denied claim.
• Performs all appeals and denial recovery procedures needed to appropriately and accurately resolve denied claims. 
• Processes required adjustments to accounts, including charges credits, payment transfers, policy adjustments, etc. in a timely and accurate manner.
• Maintains a thorough knowledge and understanding of all assigned payor contracts and requirements.
• Performs research to ensure current policies, applicable coding and insurance guidelines, regulations and laws are being followed.
• Evaluates processes and procedures and makes practical suggestions/recommendations for improvement or compliance.
• Prepares accurate and timely reports of trends and problems as they are identified. Communicates such trends to management in a timely manner.
• Consistently identifies account deficiencies that require follow up and ensures that appropriate actions have occurred.
• Completes work accurately and timely with appropriate documentation.
• Ensures that all activities related to denials management functions meet department requirements, maximize revenue collection, and achieve leading practice levels of performance.
• Consistently meets productivity and quality standards established by management, recommending new approaches for enhancing performance and productivity when appropriate.
• Keeps Supervisor/Manager informed of any problems or issues.

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:

• Provides timely billing and follow-up of assigned inventory for the purpose of expediting timely account resolution.
• Updates patient accounts to reflect any changes made to relevant information.
• Contacts payers, employers, customers, attorneys, etc. in an effort to expedite the payment of accounts.
• Processes and follows special accounts for resolution.
• Assists with any special projects as assigned.
•  Other duties assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

• High School diploma or equivalent. 

PREFERRED QUALIFICATIONS:

• Associate’s degree
• Strong written and verbal communication skills.
• Microsoft Office experience.
• Strong organization skills.
• Ability to apply strong analytical qualities.
• One (1) to two (2) years of experience in hospital or physician billing/insurance follow up.

            

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job.  It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards.  The percentages of time spent performing job duties are estimates, and should not be considered absolute.  The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole.  Incumbent must be able to perform all job functions safely.

Disclaimer

MILL Full Time Posted on 09/19/2023