What are the responsibilities and job description for the Denials Specialist position at Scottish Rite for Children?
Our patients are our number one priority! We're committed to giving children back their childhood!
Job Posting Title:
Denials Specialist
Location:
Dallas - Hospital
Additional Posting Details:
Monday - Friday
8:00 am - 4:30 pm
Job Description:
Duties/Responsibilities
- Perform research to make determination of corrective actions and take appropriate steps route account appropriately.
- Generate an appeal based on the dispute reason and contract terms specific to the payor. This includes online reconsiderations.
- Follow specific payer guidelines for appeals submission
- Escalate exhausted appeal efforts for resolution
- Research contract terms/interpretation and compile necessary supporting documentation for appeals and adjudication issues.
- Escalate denial or payment variance trends to leadership for payor escalation.
- Work payer projects as directed
Required Skills/Abilities
- High School Diploma or equivalent required, some college coursework preferred
- Minimum 3 - 5 years experience in a hospital business environment in billing, insurance follow-up with at least 2 years experience in dispute resolution.
- Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements
- Intermediate knowledge of hospital billing form requirements (UB-04 and CMS-1500)
- Intermediate understanding of ICD-9, HCPCS/CPT coding and medical terminology
- EMR experience (EPIC experience preferred).
- Critical thinking skills with a clear understanding of contractual reimbursement, adjustments, and advanced business letter writing skills to include correct use of grammar and punctuation.
- Ability to manage time, multitask and work independently.
Working Environment
- Working Conditions: Inside
- Working Position: Sitting, Walking
- Physical Demands: Light
- Physical Requirements: Repetitive Movement
- An Individual in this position will be required to lift or carry weight in this group: 11-24 lbs
- Sensory/Communicative activities essential to the performance of this position: Feeling, Hearing, Seeing, Speaking
- An Individual in this position will be exposed to: Inside environment
