Denials Management Specialist

DRISCOLL HEALTH PLAN•Corpus Christi, TX

About The Position

Under direct supervision, the Denials Management Specialist will be the first contact in accounts and determine where they go next in the denial’s process/review. They will also assist with the Billing, Follow-Up, Collection, Root Causing, Recovery, and Reporting of assigned Insurance or Self-Pay claims. Applying a scientific approach, to include research and analysis, the Denials Management Specialist will also occasionally assist with the discovery of denials or denial trends and offer recommendations for solutions as a denial preventive.

Requirements

Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience.
Minimum of one year healthcare experience in a healthcare setting.
Outstanding analytical ability and financial skills.
Work independently.
Excellent oral and written communication skills.
PC skills necessary with experience in Microsoft Office products, including PowerPoint.

Nice To Haves

Experience with denials preferred.
Understanding of payers, and coding experience preferred.
Working knowledge of managed care operations and practices preferred.
Working knowledge of health system admitting, billing, and utilization review as well as physician office practices, physician credentialing and physician billing practices preferred.
Effective communication, organization, and interpersonal skills essential.

Responsibilities

Review each account in que and determine appropriate next steps, then categorize denials for team to review and act on.
Ability to scrub account and move account forward for proper adjudication.
Able to read and understand an EOB.
Identify process errors in the organizational system or teams and assist in creating ways to limit them from occurring.
Maintains utmost level of confidentiality at all times.
Adheres to hospital policies and procedures.
Committed to professional development.
Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Occasionally assist with the Billing, Follow-Up, Collection, Root Causing, Recovery, and Reporting of assigned Insurance or Self-Pay claims.
Occasionally assist in filing appeals as appropriate to resolve payer denials and work with payers to monitor appeals in process.
Occasionally assist with other team members in functions to ensure work queues are below set threshold.
Consistently meet productivity and quality standards.
Assure patient privacy and confidentiality as appropriate or required.
Maintain professional relationships and convey relevant information to other members of the healthcare team, and within the facility.
Other duties as assigned.