Denial Management Specialist-Cert CPFSS (HB)

Good Samaritan • Vincennes, IN

5d

About The Position

Under the direction of the PB Follow Up & Denial Team Supervisor, the PB Follow Up & Denial Team Member is responsible for monitoring claims for Medicare, Medicaid, Government Payors, Commercial Payors and Work Comp Payors through claim follow up and insurance appeals.

Requirements

• Must obtain CPFSS (Certified Patient Financial Service Specialst) certification within 3-6 months upon hire date.
• Demonstrates knowledge of patient confidentiality and HIPAA regulations.
• Organized; sets priorities; meets deadlines
• Demonstrates knowledge of assigned payor processes for follow up and denials and is able to navigate the payor provider portals easily.
• Is a team player and communicates well with others.

Nice To Haves

• Helps with coverage for Customer Service when needed.
• Receive a passing score on the annual competency evaluation.

Responsibilities

• Researches and analyzes denial data and coordinates denial recovery responsibilities.
• Identifies, analyzes, and researches frequent root causes of denials and recommends corrective action plans for resolution of denials.
• Prioritizes activities to work overturns in a timely manner to alleviate untimely filings.
• Uses WQ sort/filter options to categorize denials to work to overturn denials.
• Researches, responds, and documents insurer correspondence /inquiry notes regarding coding, coverage, benefits, and reimbursement on patient accounts timely and accurately.
• Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks.
• Helps with coverage for Customer Service when needed.
• Receive a passing score on the annual competency evaluation.
• Demonstrates knowledge of patient confidentiality and HIPAA regulations.
• Organized; sets priorities; meets deadlines
• Demonstrates knowledge of assigned payor processes for follow up and denials and is able to navigate the payor provider portals easily.
• Is a team player and communicates well with others.
• Must obtain CPFSS (Certified Patient Financial Service Specialst) certification within 3-6 months upon hire date.
• Uses sort/filter options to determine priority of working claims in the Follow Up WQ by timely filing deadline and balance.
• Process payor refunds
• Answers and directs phone calls
• Updates job knowledge by participating in educational opportunities
• Complete Wellness Matters adjustments
• Print paper claims and document claim run totals
• Attach electronic medical records to claims in Waystar

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed