DENIAL MANAGEMENT SPECIALIST - TIER I

MedCentris•Hammond, LA

About The Position

Under the direction of the Assistant Director of Revenue Cycle – Revenue Recovery, the Denial Management Specialist is responsible for monitoring denials, appeals, and resolutions from participating insurance carriers and working proactively to collect from insurance carriers.

Requirements

Demonstrated understanding of medical terminology required
Knowledge of patient confidentiality and HIPAA regulations
Knowledge of CPT, HCPCS, and ICD10 coding required.
Knowledge of medical billing and collection practices
Understands Medicare and Medical Assistance regulations as they apply to job functions
Knowledge working with electronic health records (EHR/EMR) or healthcare related computer systems
Excellent written and verbal skills are required as well as outstanding interpersonal skills
Practices efficient methods for getting work done; strong ability to prioritize workload
Organized; sets priorities; meets deadlines
Ability to work independently
The employee is occasionally required to walk, use hands and fingers to feel, handle, or operate objects, tools, or controls, and reach with hands and arms.
The employee must occasionally lift and/or move objects weighing up to 25 pounds.
Specific vision abilities required by this job include close vision and the ability to adjust and focus.
Constant ability to make decisions and concentrate.

Responsibilities

Researches and analyzes denial data and coordinate denial recovery responsibilities.
Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials
Develop reporting tools that effectively measure and monitor processes throughout the denials management process in order to support process improvement.
Prioritizes activities to work overturns in a timely manner to alleviate untimely filings
Uses reports that categorize denials to assign tasks or personally work to overturn denials
Identifies and pursues opportunities for improvements in denial performance
Assists with chart audits as necessary
Processes work lists to facilitate prompt intervention of insurance denials
Researches, responds, and documents insurer and patient correspondence/inquiry notes regarding coding coverage, benefits, and reimbursement on patient accounts
Research rejections included in EOBs for resolution and files appropriately
Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks
Runs daily report from the REG and compare to the PBR daily to ensure all insurance changes have been entered on both sides.
Helps with coverage for the Financial Coordinator when she is out of the office.
Helps when needed with retrieving mail delivered to office and sorts appropriately.