What are the responsibilities and job description for the Denial Management, Revenue Cycle Specialist position at The CCS Companies?
Job Details
Job Location: Norwood Office - Norwood, MA
Salary Range: Undisclosed
Description
POSITION SUMMARY:
The Denial Management, Revenue Cycle Specialist is responsible for analyzing, tracking and resolving healthcare insurance denials to ensure optimal reimbursement and the financial stability of our clients.
ESSENTIAL FUNCTIONS:
- Reviews and analyzes insurance denials to determine root causes and implement effective resolution strategies.
- Collaborates with account managers, billing departments and insurance companies to resolve denied claims promptly.
- Maintains up-to-date knowledge of insurance policies, coding regulations, and compliance requirements to minimize denials.
- Tracks and documents denial activities to help identify opportunities for process improvements to reduce future claim denials.
- Utilizes detailed reports on denial trends, patterns and KPIs as generated by management.
- Maintains the highest level of privacy in accordance with HIPAA requirements and laws.
- Appeals denied claims by preparing and submitting necessary documentation and communicating with the insurance companies.
- Ensures timely and accurate follow-up on all outstanding denied claims.
- Contacts patients, payers, hospitals, attorneys, employers, and any other parties involved to collect the necessary information and ensure reimbursement for our client.
- Meets monthly company, team, and individual goals, and all deadlines set by the Manager, Denial Management.
- Completes special projects, as requested.
- Ability to maintain consistent and regular attendance in accordance with an established schedule.
- Ability to work onsite/in-office in accordance with CCS and department policies and procedures.
QUALIFICATIONS:
- Minimum of 3 to 5 years of directly related industry experience.
- Proficiency in denial management systems, healthcare billing software and electronic health records (EHR).
- Experience with EPIC is required.
- Strong analytical skills with the ability to interpret complex data and generated actionable insights.
- Ability to interpret EOBs and knowledge of how to resolve denials.
- Excellent communication and interpersonal skills, with the ability work effectively with diverse teams.
- Detail oriented with strong organizational skills and the ability to manage multiple tasks simultaneously.
- Knowledge of medical terminology, coding (ICD-10, CPT) and insurance policies.
- Ability to speak confidently over the phone.
- Demonstrated knowledge of state laws and insurance statutes.
- Certifications preferred but not required:
- Certified Professional Coder (CPC)
- Certified Coding Specialist (CCS)
- Certified Healthcare Financial Professional (CHFP)
- Coachable: receptive to feedback, willing to learn, embraces continuous improvement, and responsive to change.
EDUCATIONAL REQUIREMENTS:
- Bachelor’s degree in Healthcare Administration, Business, Finance or related field preferred.
- Five (5) years of directly related experience in medical billing, coding or denial management within a healthcare setting in lieu of degree.
Qualifications
