Denials Management Specialist

Baptist Health

19h

About The Position

The Denials Management Specialist shall be responsible to validate dispute reasons, escalate payment variance trends or issues to management, and generate appeals for denied or underpaid claims. This individual will resolve complex and aged accounts. Resolution of accounts may include research of payer and governmental regulations and billing rules, payment research, review of all aspects of the claim such as member information, CPT and diagnosis codes, review of medical records, analysis of managed care contracts and review of the chargemaster. The Specialist will have in-depth knowledge of payer contracts, billing rules, and administrative guidelines in order to effectively review and analyze denials and underpayments. The Specialist will provide meaningful feedback and recommendations to Managed Care, Revenue Integrity, and leadership teams regarding any trends or issues and will escalate as needed through payer provider advocates and contracting teams. Additionally, this individual will work collaboratively with other areas in attempts to resolve or minimize ongoing denials and underpayments. The Specialist will accurately and thoroughly document all pertinent collection activity performed. This position may have additional duties assigned that are within scope of the role.

Requirements

High School diploma or equivalent required.
Minimum of at least 3 years’ experience in a hospital business or medical office environment performing billing and/or collections.
Excellent knowledge of MS Office and familiarity with relevant computer software.
Strong team leadership skills, strong organization, interpersonal, and customer relations skills.
Must be able to meet strict deadlines.
Strong analytical and problem-solving ability, and excellent organizational skills.
Must be able to complete multiple tasks simultaneously.
Ability to remain calm in difficult situations.
Strong written and oral communication skills, proficient computer skills, proven track record of successful performance.
Ability to understand complex multifactor situations and bring appropriate solutions.
Ability to work both independently and in a team environment.
Knowledge of ICD-9, ICD-10, and CPT coding.

Nice To Haves

Associates degree or higher preferred.
CRCR or CPAR certification preferred

Responsibilities

validate dispute reasons
escalate payment variance trends or issues to management
generate appeals for denied or underpaid claims
resolve complex and aged accounts
research of payer and governmental regulations and billing rules
payment research
review of all aspects of the claim such as member information, CPT and diagnosis codes
review of medical records
analysis of managed care contracts and review of the chargemaster
provide meaningful feedback and recommendations to Managed Care, Revenue Integrity, and leadership teams regarding any trends or issues
escalate as needed through payer provider advocates and contracting teams
work collaboratively with other areas in attempts to resolve or minimize ongoing denials and underpayments
accurately and thoroughly document all pertinent collection activity performed
additional duties assigned that are within scope of the role