Denial Management Specialist, IPN, Full Time

Iredell Memorial Hospital Incorporated•Statesville, NC

About The Position

The Denial Management Specialist performs clinical denial management, focusing on claim denials related to authorization, medical record requests, and coordination of benefits. The role manages, maintains, and communicates denial and appeal activity to appropriate stakeholders, and independently plans and organizes work that affects reimbursement. The specialist conducts comprehensive reviews of denied claims and accounts to determine actions needed to obtain reimbursement and minimize organizational write-offs. The specialist reviews denied claims for appropriate coding, ensures billing and coding are correct before appeals or reconsiderations are sent, investigates claims with no payer response, and works follow-up queues. The role also identifies missing payments and overpayments, analyzes account credits, tracks information requests, and works with the IPN Revenue Cycle Team to resolve charge questions. It requires familiarity with payer websites and appeal processes, including those of commercial and government payers. The position includes identifying denial trends, assisting with coding issues, staying current with compliance and regulatory changes, documenting issues and resolutions, and providing timely reports to management. The specialist supports quality and process improvement, responds proactively to questions and concerns, and meets management goals for accuracy, productivity, and compliance. Other duties may be assigned.

Requirements

High school diploma or GED.
Demonstrated knowledge of and experience in professional medical billing, claim processing, follow-up, and appeals.
Strong reasoning, critical-thinking, analytical, and mathematical skills.
Ability to work independently, shift flexibly between broad and detailed tasks, maintain high productivity, and regularly meet deadlines.
Ability to use email, search engines, the Internet, payer websites, and Microsoft Outlook, Word, and Excel.
Ability to meet the position's essential physical requirements, including passing a basic FIT test; walking, kneeling, standing, pushing, pulling, bending, stooping, reaching, and sitting for extended periods; lifting and carrying up to 25 pounds; and using a calculator and computer keyboard.

Nice To Haves

At least 3 years of experience in a medical billing department with strong accounts receivable follow-up, appeals, and coding knowledge is preferred.
CPC certification is preferred but not required.
Working knowledge and experience with Cerner EHR is strongly preferred but not required.

Responsibilities

Manage claim denials related to authorization, medical record requests, and coordination of benefits.
Maintain and communicate denial and appeal activity to appropriate stakeholders.
Review denied claims and accounts to determine actions needed to obtain reimbursement.
Review denied claims for coding appropriateness and make corrections as needed.
Ensure billing and coding are correct before submitting appeals or reconsiderations to payers.
Investigate claims for which there has been no payer response and confirm whether the payer received the claim.
Identify denial trends and patterns to help prevent errors.
Assist and confer with coding concerning coding problems.
Stay current with compliance requirements and changing regulatory guidelines.
Support and participate in process and quality improvement initiatives.
Meet management goals for error-free work, transactions, processes, and compliance.
Resolve issues proactively and respond to questions and concerns in a timely manner.
Document issues and resolutions clearly.
Deliver required reports to management on time and communicate resolutions, including payer denial trends caused by coding and billing errors.
Work follow-up queues.
Identify missing payments and overpayments, and analyze account credits.
Track and follow up on information requests.
Work with the IPN Revenue Cycle Team to share information and resolve charge questions.
Perform other duties as assigned.