Accounts Receivable Denial Specialist

Behavioral Health Network•Springfield, MA

1d•Remote

About The Position

This role focuses on ensuring timely reimbursement by following up on assigned claims, reviewing denied claims for accuracy, and investigating claims with no payer response. The specialist will navigate various payer websites and appeal processes, identify trends in denials to prevent future errors, and assist with coding and modifier setup issues. Additionally, the role involves identifying missing payments, overpayments, analyzing account credits, and initiating refund requests for credit and overpayments.

Requirements

High School Diploma or GED required.
Minimum of 5 years of experience in a medical billing department with strong AR account follow-up, appeals, and Behavioral Health codes and modifier knowledge required.
Demonstrated knowledge of and experience in healthcare medical billing, claims processing, follow-up, and appeals required.
Must be a critical thinker with strong research, analytical, and mathematical skills required.
Current knowledge of HIPAA compliance, 42 CFR requirements, and changing regulatory guidelines.
Extensive comprehension in utilizing email, search engines, and the Internet with the ability to effectively use payer websites.

Nice To Haves

Carelogic EHR with working knowledge and experience is a strong preference but not required.

Responsibilities

Follows up on all assigned claims (at 45 days, 60 days, and 90 days) to ensure timely reimbursement and bring claims to closure.
Reviews denied claims for accuracy to ensure coding, billing rates, and modifiers are accurate before sending appeals or reconsiderations to payers.
Investigates claims with no payer response to ensure the payer received the claim.
Navigates payer websites and appeal processes as defined by all payers including commercial and government payers including Mass Health, Tricare, Medicare, Medicaid, and Medicare Advantage plans.
Reviews and finds trends or patterns of denials to prevent errors.
Assists and confers with the EHR Matrix team and Billing Manager concerning any coding or modifier setup issues.
Responsible for identifying missing payments, overpayments, and analyzing credits on accounts.
Initiates refund requests for credit and overpayments.