What are the responsibilities and job description for the Denials Management Specialist - McLaren Careers position at McLaren Health Care?
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 :
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.
Qualifications
Required :
Associate degree required.
Minimum of 3 years in a hospital or physician billing office.
Equal Opportunity Employer of Minorities / Females / Disabled / Veterans
