Customer Support and Denial Specialist

Iowa Radiology P C•West Des Moines, IA

13h

About The Position

Professional Medical Management (PMM), which supports Iowa Radiology, is seeking a Customer Support and Denial Specialist to help resolve claim denials, follow up on outstanding claims, and provide service to patients. The role is part of the Accounting/Finance department and reports to the Billing Manager. It is full-time, during normal office hours Monday through Friday, and can be based at the PMM office or a home office. The specialist works with insurance carriers, patients, provider offices, clinic staff, and billing colleagues to resolve claim issues and support billing operations. Duties include handling denied and outstanding claims, responding to patient account inquiries, processing billing correspondence, and reviewing and correcting electronic and paper claim documentation. The role requires attention to detail, effective communication, independent work, and collaboration with the billing team.

Requirements

High school diploma or equivalent (GED) required.
At least two years of billing and insurance experience required.
Experience with email, the internet, and Microsoft Office products.
Ability to read, write, and speak fluent English.
Ability to communicate effectively with internal team members and external customers.
Excellent organizational skills and ability to multitask and make quick, accurate decisions.
Ability to communicate effectively and work independently.
Continuous mental and visual concentration requiring attention to detail and accuracy.
Manual dexterity to operate a computer and other office equipment.
Ability to perform repetitive tasks associated with technology use, including phone, computer, applications, and software.
Ability to bend, stoop, kneel, or crouch as part of job functions.
Ability to lift and carry up to 25 pounds when necessary.

Nice To Haves

Knowledge of CPT and ICD-10 coding, modifiers, and insurance specifications preferred.

Responsibilities

Work denied claims from the Denial Tickler and determine the action needed for resolution.
Assess whether denials are justified, document findings, move balances to patient responsibility, or refer matters for adjustment or write-off approval.
Prepare and submit appeals, and follow carrier-specific appeal levels and processes.
Contact insurance carriers by email, web inquiry, or phone to gather information.
Correct and refile claims, including insurance policy IDs and prior authorization information; coding changes require approval by a certified coder.
Request insurance information, medical necessity documentation, records, or orders from ordering provider offices.
Track timely filing and appeal deadlines, prioritize work, and communicate carrier requirements and denial trends to Billing and Coding managers.
Investigate outstanding claims in the tickler queue using carrier websites and phone contact, and resolve processing issues.
Provide credit balance information to the refund department and provide payment posters with documentation for insurance responses when appropriate.
Assist patients with account inquiries by phone, mail, email, and voicemail.
Process credit card payments in accordance with PCI requirements.
Provide price quotes and billing expectations for upcoming appointments, including good faith estimates for self-pay or uninsured patients.
Set up reasonable payment plans and help patients execute payment methods.
Work with clinic staff to answer billing and balance inquiries in patient-facing clinics.
Review electronic claim rejections, research rejection messages, make necessary changes, and rebill services.
Review pre-eligibility checks and verify suggested charges are appropriate.
Review returned mail from patients and insurance companies and take action according to protocols.
Review, document, distribute, resolve, and scan incoming mail and fax correspondence.
Review health insurance claim forms (CMS-1500/UB-04) and attachments for accuracy.
Scan and index documentation into the document management system.
Collaborate with billing office team members to complete billing processes timely and efficiently.
Attend staff meetings and education workshops or training.
Report staffing, morale, work-method, and procedure problems to the Billing Manager.
Perform other duties as assigned.