The Multispecialty Denials Specialist will review documentation and coding guidelines for profession fee-based coding, evaluation and management services, procedures, and diagnoses. Researching claim denials, submitting appeals, following up on outstanding claims, and handling claims correspondence. This is a full-time or part-time temporary project working remotely.
Essential Job duties and Responsibilities:

• Research payer denials related to referral, pre-authorization, eligibility/registration, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
• Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as client’s policies and procedures.
• Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
• Demonstrate knowledge and understanding of insurance billing procedures as evidenced by the identification of root-causes of claim issues and proposed resolutions to ensure timely and appropriate payment.
• Ensure appropriate revenue is captured; to prevent federal and payer audits, malpractice litigation, and health plan denials.

Requirements:

• Proficiency with MS Office Suite and Athena software
• Profee multispecialty coding: 2 years
• Physician based Denials: 5 years
• (AAPC) CPC and/or (AHIMA) CCS, CCS-P, or RHIT certification
• Knowledge of medical terminology, insurance and appeals processes, and medical record management
• High level of accuracy and attention to detail
• Strong written and verbal communication skills