What are the responsibilities and job description for the Denials Management Specialist position at McLaren Health Care Corporation?
Position Summary :
The denials management specialist is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The specialist will work independently while managing their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered.
Essential Functions and Responsibilities:
- Monitors denial work queues and reports in accordance with assignments from direct supervisor. Maintains required levels of productivity while managing tasks in work queues to ensure timeliness of follow-up and appeals.
- Tracks and investigates denial trends/ root cause
- Assists with claim audits as necessary
- Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.
- Obtain retro authorizations and submit to payers for reimbursement.
- Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.
- As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.
- Works independently with other departments to resolve A/R and payer issues.
Qualifications
Required:
· Associate degree required.
· Minimum of 3 years in a hospital or physician billing office.
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
Additional Information- Schedule: Full-time
- Requisition ID: 25000246
- Daily Work Times: Standard Business Hours
- Hours Per Pay Period: 80
- On Call: No
- Weekends: No