Denial & Reconsiderations Specialist

Larkin Community Hospital • South Miami, FL

3d • Onsite

About The Position

Under the direction of the Business Office Director, the Denials and Reconsideration Specialist is responsible for administrative denial management. Conducts a comprehensive review of the denied account, and then will write compelling arguments based on the documentation and the policies of the payer and submit the appeal in a timely manner.

Requirements

• High School diploma of equivalent
• Five or more year’s denials management and appeals documentation experience.
• Prior experience in healthcare claims processing and proficiency with medical billing and remittance forms.
• Expert knowledge in Medicare, Medicaid, Managed Care and Commercial hospital billing and collections.
• Proficiency in medical terminology, coding systems and medical billing procedures.
• Demonstrate ability to research and resolve difficult claim denials and documentation issues.

Nice To Haves

• additional certifications or education in medical billing/coding preferred

Responsibilities

• Prepare appeal and/or reconsideration letters for administrative denials by accessing specific payer appeal forms, submitting appropriate medical documentation, and tracking appeal resolution.
• Follow up on submitted appeals through payer portals or phone calls to payer.
• Identify denial trends, root cause and A/R impact.
• Seek resolution to problematic accounts and payment discrepancies.
• Follows account to timely resolution to include appropriate financial adjustment.
• Ensures compliance with current state, federal and CMS regulations.
• Maintains working knowledge of applicable insurance carrier’s timely filing deadlines, claims submissions processes, and appeals processes.
• Performs related duties as required.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED