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 Graduate with some College

Experience

• 5 years’ experience in medical billing/collections setting with experience with denials, appeals, insurance collections and related follow-up.
• Must have extensive knowledge of ICD9 and CPT-4 coding and modifiers usage.
• 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 Analytical skills.
• Good Communication Skills

License/Registration/Certifications

• If in Professional Billing Services: CPC certification
• If in Hospital Billing Services: CRCA or CPC-H certification

Preferred Requirements

Preferred Education

• N/A

Preferred Experience

• Focused denials and appeals management experience.
• Possess an in-depth working knowledge and experience with all types of insurance billing guidelines: Commercial, Medicare Part A and B, Medicaid, Managed Care plans etc.
• Team lead or supervisory experience.

Preferred License/Registration/Certifications

• If in Hospital Billing Services: an AAPC credential

Core Job Responsibilities

• Responsible to review and resolve all daily claim scrubbers edits based on coding/billing guidelines.
• Research and resolve all outstanding denials within work cue 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.
• Function as a denials team resource to other associates within the department
• Ability to lead a team meeting and teach specific task and procedures to other associates.
• Must be cross-trained and functional in all areas within the department as it relates to A/R and denials.
• Ability to work closely with multiple department leaders and/or staff to improve revenue integrity.
• Complete special projects as assigned by Supervisor/Manager
• Prepare/attend AR denial meetings as required.