What are the responsibilities and job description for the DENIALS RECOVERY SPECIALIST position at Moffitt Cancer Center Careers?
At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America’s Best Large Employers and America’s Best Employers for Women, Computerworld magazine’s list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time’s Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet® designation in recognition of its nursing excellence.
Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and the leading cancer hospital in both Florida and the Southeast. We are a top 10 nationally ranked cancer center by Newsweek and have been nationally ranked by U.S. News & World Report since 1999.
Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision.
Summary
Position Highlights:
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Responsible for the coordination and management of timely insurance claim follow-up including identifying, monitoring, appealing, and resolving denied claims. Perform detailed analysis on denied claims with a focus on maximizing revenue
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The Ideal Candidate:
- In depth knowledge of Medicare and Medicaid regulations, third party reimbursement guidelines.
- Computer literate, knowledge of financial data analysis, intermediate Excel skills.
- Preferred – Physician claims experience in a multi-specialty environment, preferably with oncology and/or surgical experience.
Responsibilities:
- Follow-up electronically and/or telephonically with payors for claim and appeal status.
- Make a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted.
- Research and prepare responses for payor requests for additional information and documentation.
- Review of non-clinical denials including identification of root cause.
- Resolve non-clinical denials which include researching and reviewing payor guidelines, writing and submitting appeals with supporting documentation if required.
- Other duties as assigned.
Credentials and Qualifications:
- Associate degree required.
- A minimum of three (3) years’ experience working with medical claims in a hospital, physician, payor or third-party medical billing service setting with collection experience.
- * "in lieu of" Associate's, a H.S. Diploma with two (2) years of additional related claims/collection experience (total of 5) may be considered.
