Denials Management Specialist

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:

1. 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.
2. Tracks and investigates denial trends/ root cause
3. Assists with claim audits as necessary
4. Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.
5. Obtain retro authorizations and submit to payers for reimbursement.
6. Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.
7. As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.
8. Works independently with other departments to resolve A/R and payer issues.

Qualifications

· Associate degree required.

· Minimum of 3 years in a hospital or physician billing office.

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

• Schedule: Full-time
• Requisition ID: 25000246
• Daily Work Times: Standard Business Hours
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No