What are the responsibilities and job description for the Denial Management Specialist position at Medical Network of Alaska?
MNA Delivers leadership, support, and guidance to healthcare facilities of all sizes across multiple specialists with the primary goal of providing accessibility, value, and quality medical administrative support services.
What You’ll Do:
Responsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues, and generating appeals for denied or underpaid claims.
- Validate denial reasons and ensure coding in EMR accurately reflects the denial reasons.
- Generate appeals based on the dispute reason and contract terms specific to the payor.
- Follow specific payer guidelines for appeals submission.
- Work payer projects as directed.
- Research contract terms/interpretation and compile necessary supporting documentation for appeals.
- Perform research, determine corrective actions, and take appropriate steps to route account appropriately.
- Escalate denial or payment variance trends for payor escalation.
What You Need For This Job:
- High School Diploma or general education degree
- One-year related billing experience and/or training; or equivalent combinations of education and experience.
- Must reside in or near Wasilla, Alaska.
- Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
- Ability to write routine reports and correspondence.
- Ability to speak effectively before groups of customers or employees of the organization.
- Ability to add, subtract, multiple and divide in all units of measure, using whole numbers, common fractions and decimals.
- To perform this job successfully, an individual should have knowledge of Database software, internet software and work processing software.
- Ability to regularly sit, stand, walk, use hands, or feel and talk and hear. Ability to occasionally sit, reach with hands and arms; stoop; kneel; crouch, or crawl.
- Must be able to lift and/or move 50 lbs.
- Specific vision abilities required by this job include close vision, distance vision, color vision, depth perception, and the ability to adjust focus.
- The noise level in the work environment is usually moderate.
Reasonable accommodations may be made to enable individuals with a disability to perform essential functions.
What You’ll Love About Us:
- Great Company Culture- We embrace diverse perspectives and prove the freedom to grow, innovate and create.
- Rest and Relaxation- Enjoy 15 days of paid time off with an increase after five years and six paid holidays!
- Health Benefits- Access to medical, dental, and vision plans, with HSA and FSA options, as well as short- and long-term disability coverage. We also provide $25,000 in employer-paid life insurance for added peace of mind.
- Prepare for the future- Fidelity 401(k) with a generous employer match of up to 4.5% and access to a personal financial planner.
- Healthy Working Environment- We prioritize a safe, empowering, and inclusive work culture.
Because our team members are trusted to handle sensitive information, we require all candidates that receive and accept employment offers to complete a background check and drug screen before official employment.
Medical Network of Alaska, LLC is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.
Salary : $22
