Denial Prevention Specialist

SGA•Weatherford, TX

22h•$20 - $22•Remote

About The Position

Responsibilities : The successful candidate will review, research, and resolve claim denials and appeals for various insurance companies while identifying payment trends in an effort to maximize collections. A successful candidate should have, but not be limited to the following skills: Capable of reviewing Explanation of Benefits (EOB) from payors to determine how the claims were managed. Contacting insurance carriers to check on the status of claims, appeals, and insurance verification. · Knowledgeable with payors including Managed Care, Commercial, Medicare, and Medicaid · Preparing/Submitting appeals related to denied services Analyze payer denials by denial groupers and submit appeals. Contact patients and/or third party payers to resolve outstanding insurance balances and underpaid claims. Make necessary adjustments as required by plan reimbursement. Functions as a liaison between clinical departments and MSRDP management team. Completes special projects as assigned. Performs other duties as assigned.

Requirements

High School Diploma or Associate's Degree
2 years experience in medical claims recovery and/or collections required
Work requires a self-starter, with ability to work well as part of a team and independently.
Work requires ability to communicate effectively with patients, insurance companies, clinical staff and management.
Work requires ability to handle large volumes of work.
Work requires ability to work in a fast paced, production oriented environment.
Work requires excellent customer service skills.
Work requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment.
Work requires good organizational, flexibility and analytical skills when resolving more complex unpaid claims.
Work requires knowledge of billing and/or collections and regulations.
Work requires knowledge of CMS 1500, ICD-9, and CPT coding is preferred.
Work requires one to exhibit excellent work ethics and commitment to job responsibilities.
Work requires one to possess a professional and courteous demeanor while being assertive and confident in their collection efforts.
Work requires one to possess quick and accurate alpha/numeric data entry skills.
Work requires presence of a positive image that reflects well on the organization.
Work requires strong written and verbal communication skills.
Work requires understanding of the requirements of Medicaid, Medicare and insurance billing.

Responsibilities

Review, research, and resolve claim denials and appeals for various insurance companies while identifying payment trends in an effort to maximize collections.
Review Explanation of Benefits (EOB) from payors to determine how the claims were managed.
Contact insurance carriers to check on the status of claims, appeals, and insurance verification.
Prepare/Submit appeals related to denied services
Analyze payer denials by denial groupers and submit appeals.
Contact patients and/or third party payers to resolve outstanding insurance balances and underpaid claims.
Make necessary adjustments as required by plan reimbursement.
Functions as a liaison between clinical departments and MSRDP management team.
Completes special projects as assigned.
Performs other duties as assigned.