Denials Specialist/Billing

Basic Function and Scope of Responsibilities: This job is responsible for corresponding with health insurance payers to address and resolve outstanding insurance balances related to coding denials in accordance with established standards, guidelines and requirements. An incumbent conducts follow-up process activity through review of medical records and contact with providers, phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals. Work requires proactive troubleshooting, significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies and bring timely resolution to issues that have a potential impact on revenues. In addition, the incumbent must be able to communicate effectively with payer representatives and maintain professional communication with team members in order to support denials resolution.

Principle Responsibilities:

• Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is receive
• Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
• Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
• Review patient medical record to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc.
• Communicate with provider to resolve claims that require a written appeal or second level appeal. Resubmits claims with necessary information when requested through paper or electronic methods.
• Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
• Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
• Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Education Requirements:

• Bachelor or Associate degree in accounting or business-related preferred
• 3-5 years of medical billing experience preferred

Performance Requirements

Knowledge:

• Experience in health care claims coding and payment process
• Knowledge of health care systems and inter/intra-relationships; hospital finance, revenue cycle, and information systems
• Knowledge of types of health information and the rules and regulations surrounding their use.
• Familiar with medical billing software systems
• Knowledge of complex managed care concepts and processes
• Knowledge of health insurance pricing and associated benefit designs and provider billing and claims processing.
• Familiar with HIPAA
• Evaluates and understands contractual language and health plan payment policies as it relates to payment, compliance, reimbursement methodologies, and appeals processes.

Skills and Abilities:

• Demonstrate strong communications skills, both on the phone and in writing, with a strong understanding of medical terminology and a high level of attention to detail.
• Skills in management and interpretation of data
• Strong microcomputer skills (including spreadsheet, database, and word processing software).
• Read an interpret contract language and reimbursement mechanisms
• Develop and maintain positive working relationships with senior management, physicians, hospital staff, and payers, managed care company representatives
• Ability to communicate effectively and professionally with all levels of staff and customers.

Must possess the physical and mental abilities to perform the tasks normally associated with the role including bending, reaching and sitting.

Physical surroundings: Medical office

Adverse working environment: Work may be stressful due to continual interaction with others, long hours required and nature of the medical specialty.

Physical Effort: Must possess the physical and mental abilities to perform the tasks normally associated with this role including walking, bending, standing, reaching, and sitting. Lifting up to 10 pounds of technology equipment.

Local Travel: Occasional, within city limits only

Domestic/International Travel: None

Extensive Hours: Varies due to need

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this position. They are not intended to be an exhaustive list of all associated responsibilities, skills, efforts or working conditions. Mission Cancer Blood, part of University of Iowa Health Care reserves the right to change, amend, add, delete and otherwise assign any and all duties, responsibilities and position titles as it deems necessary to meet the needs of the business.

Mission Cancer Blood, part of University of Iowa Health Care is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender, sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need.

In the interest of ensuring the safety of our employees, patients and community, Mission Cancer Blood, part of University of Iowa Health Care has adopted a mandatory vaccination policy for COVID-19. All employees are required to be fully vaccinated against COVID-19 unless granted a reasonable accommodation for disability, religious or other extenuating circumstances. New employees will be granted a reasonable time to come into compliance with the policy, if necessary.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Ability to Commute:

• Des Moines, IA 50309 (Required)

Ability to Relocate:

• Des Moines, IA 50309: Relocate before starting work (Required)

Work Location: In person