DENIAL SPECIALIST-NSA

Job Description

Job Description

Summary : Analyzes health care insurance / litigation patient account files and contacting insurance companies and patients to resolve any and all outstanding and delinquent insurance payments due to the health care client.

Collection Goal : Determined monthly

General requirements :

• Perform basic duties as assigned in a professional manner, which includes interacting with clients, insurance payors, attorneys and team members as needed.
• Responds promptly to emails and telephone messages.
• Participates in meetings, training sessions, seminars and in-services in a positive and professional manner.
• Basic computer skills to navigate through various systems and applications provides for working accounts to resolution.
• Good oral and written skills are required.
• Must have basic Excel skills
• Knowledge in working all payor websites : Availity, UHC : Medicare and all others to find status on accounts, upload Medical Records, file a Reconsideration, Appeal, pull EOB’s, UB04s and all Correspondence needed to work an account.
• Document clear and concise notes in our TCS system regarding claim status, denial reason and next steps
• Maintain individual productivity goals of an average of 45 accounts per day.
• Communicate all issues including system, compliance, payor, behavior, workflow or any other insurance collection opportunities to management immediately.
• Provide support for team members that me be out or backlogged willingly.
• Work projects or other duties as assigned.
• Must have above average analytical and critical thinking skills.
• Must be able to make sound decisions.
• Must have the ability to problem solve, prioritize duties and follow through completely with assigned tasks.
• Must have a good understanding of the Commercial, Managed Care, Medicare collection processes and a basic knowledge of Managed Care contracts, Contract Language and Federal and State Requirements for government payors.

Essential Duties & Responsibilities :

Competency :

To perform the job successfully, an individual should demonstrate the following competencies : Responds promptly to client needs & meets commitments. Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; supports everyone's efforts to succeed; recognizes accomplishments of other team members. Follows policies and procedures; completes administrative tasks correctly and on time; supports organization's goals and values. Is consistently at work and on time; ensures work responsibilities are covered when absent; Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; completes tasks on time or notifies appropriate person with an alternate plan. Approaches others in a tactful manner; treats others with respect and consideration regardless of their status or position. Meets productivity standards; completes work in timely manner; strives to increase productivity; works quickly.

Qualifications :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education / Experience :

Must have NSA Experience (Federal Preffered)

College degree preferred but not required. Required, high school diploma. Three to five years related experience in health care insurance collections is required.

Language Ability :

Bilingual in Spanish and English is a plus but not required. Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to draft simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Math Ability :

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

Reasoning Ability :

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.

Computer Skills :

To perform this job successfully, an individual should have knowledge in Microsoft Office Word and Excel is required.

Certificates and Licenses : N / A

Work Environment :

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Physical Demands :

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. Specific vision abilities required by this job include Close vision.