Medical Denial Specialist

Overview 

IMMEDIATE opening in Greenville for Medical Denial Specialists. We are seeking proactive problem solvers with time management skills that are interested in joining a great team and growing practice. Medical billing experience is required with Epic experience preferred. We will train to ADD TO YOUR current medical billing skills/experience! COME LEARN AND GROW WITH US!

Job Title: Medical Denial Specialist

Job Type: Full time

Location: 203 Mills Avenue Greenville, SC 29605 (this is an in-person position)

Practice Overview: We are a growing medical practice with 9 office locations across the upstate. Our providers care for patients at 21 dialysis locations and multiple hospitals as well.

Job Description

The Denial Specialist is responsible for working denials that are categorized by payer/place of service in various work queues. This includes, but is not limited to, investigating specific denial categories and codes, finding the underlying reason for the denial, correcting the issue and rebilling the claim to ensure that we are properly reimbursed. Overpayment letters from payers that are sent by mail will also be part of this job description.

Working as a team which includes, but is not limited to, answering incoming phone calls, assisting patients with billing questions, and helping one another when needed.

Responsibilities

Claims

·      Appealing denied claims, including researching underlying root cause, collecting required information, adjusting the account as necessary, resubmitting claims to avoid past timely filing guidelines, and all appropriate follow up activities to ensure adjudication of the claim.

·      Contacting payers via portals or phone to work the denial efficiently.

·      Following up on outstanding claims.

·      Insurance verification via portals when appropriate.

·      Issuing/requesting payer refunds when appropriate.

Patient Interactions

Phone calls or mailing patient letters:

·      Answering patient questions/concerns.

·      Calling patient when needed for any information needed regarding a claim. 

·      Collecting patient payments via phone by card.

·      Coordination of benefits letters.

·      Updating and/or verifying patient insurance information into their registration.  

Overpayment Letters - Payers requesting refunds due to various reasons.

·      Researching the information on the letter to confirm it is valid.

·      Resubmitting the claim to another payer if possible.

·      Submitting refund request and finishing the refund process to the payer.

Benefits

·      401(k).

·      Dental insurance.

·      Health insurance.

·      Life insurance.

·      Paid time off.

·      Vision insurance.

Expected Schedule

·      Monday-Friday (8:30-5:00)

·      35-40 hours per week.

Pay

·      $16.00-$21.00 per hour

Requirements

Essential Requirements

·      1 year of medical billing experience specifically with appeals, corrected claims, denials, and verification of insurance information.

·      Ability to read an explanation of benefits from payers.

·      Comfortable communicating denial root causes/resolution to leadership as needed.

·      Willing to learn and adapt to updated billing guidelines and/or new changes within the practice.

Preferred Skills

·      Epic experience.

·      Experience with various payers regarding appeals, corrected claims and denials.

·      Familiarity with various insurance portals.