Denials Management Specialist

Nevada System of Higher Education•Arlington Heights, IL

1d•$22 - $33

About The Position

Reviews claim denials which pertain to medical necessity, pre-certification, authorization, and level of care requirements. This involves interaction with Physician Practices, Providers and Payers.

Requirements

High School Required
2 Years previous patient billing Or 2 Years managed care experience
Extensive computer knowledge and experience.
Knowledge of standard billing guidelines, CPT/ICD9 coding, usual and customary (U& C) schedules

Responsibilities

Reviews and resolves denied patient insurance claims.
Works closely with internal departments in determining accurate denial and process for appeal.
Contacts insurance companies/payer or patients to gather information necessary to complete the appeal process.
Sends appeals to insurance companies regarding denials by resubmitting corrected claim, submitting medical records and writing appeals letters in a timely manner
Provides process improvement recommendations to Supervisor to decrease future denials.
Utilizes software tools to identify denial, trends and payer issues. Shares findings with stakeholders.
Follows up on pending claim denials after appeal has been processed -by the insurance company.
Collaborates in the collection of data and sends monthly “Managed Care Denial Report” to appropriate department Leaders including: Physician Coding Manager; Physician Billing Manager and Director, VP of EEH Physician Practices and Vice President of EEH Revenue Cycle.
Maintains positive working relationships both externally and internally.