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Sound Physicians - Dallas, TX

posted 15 days ago

Full-time - Entry Level
Remote - Dallas, TX
Ambulatory Health Care Services

About the position

The Denials Management Billing Specialist is responsible for following payor guidelines, legislation and regulations. They are responsible to track, trend and provide root cause analysis of denials received by payors. The Specialist works to eliminate denials allowing the organization to realize a decrease in the volume of denied accounts and dollars. Candidates should have experience with a minimum of one of our core service lines.

Responsibilities

  • Auditing denial adjustment requests from billing vendors, field operations and Sound Physician staff
  • Working closely with Regional Operations, Contracting, Coding, Compliance, Payers, Billing companies and the Denials Committee to address issues affecting appropriate reimbursement
  • Researching and analyzing denial trending and root cause by payer and region. Compiling data on inappropriate high volume denial types and working with payors, contracting and billing companies to resolve
  • Maintaining documentation and participating in external audits in order to validate compliance with Sound Physicians policies surrounding denial adjustment requests
  • Participating in Denials Management Committee meetings and providing feedback on areas requiring improvement for denials resolution
  • Reviewing, working and trending vendor escalations
  • Reviewing denial and payer trends for resolution
  • Partnering with vendor to resolve denial and unpaid claims
  • Reconciling approved adjustments to ensure that they have been posted and closed in the billing system timely, ensuring aging buckets do not increase
  • Assisting department leadership with ad-hoc reports, research, analysis and special projects
  • Managing time effectively to complete assignments within established time frames, optimizing collections, and meeting performance goals
  • Other duties as assigned

Requirements

  • High school diploma or equivalent required
  • 3-5 years' experience in medical insurance authorization, billing, patient accounts or related role required
  • Experience in denial and claims resolution required
  • Advanced understanding/knowledge of computer data entry, Microsoft Excel and ability to navigate through any business related software
  • Knowledge and skilled in the use of a computers and related systems and software
  • Maintains current knowledge base for regulations: state, federal, and commercial payors

Nice-to-haves

  • Demonstrated track record of a strong work ethic
  • Proactive 'can-do' attitude
  • Willingness to accept feedback and be coachable
  • Customer-focused mindset
  • Eager to learn and embrace new information
  • Team player with a collaborative spirit
  • Adaptability to changing circumstances
  • Resourcefulness in problem-solving
  • Commitment to the job and organization

Benefits

  • Medical insurance
  • Dental insurance
  • Vision insurance
  • Health care and dependent care flexible spending account
  • 401(k) retirement savings plan with a company match
  • Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year
  • Ten company-paid holidays per year
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