Denials Management Specialist

Symetria Recovery•Naperville, IL

About The Position

Symetria Recovery is the #1 outpatient rehab in Illinois and Texas. It started with three simple, yet game-changing core beliefs: Addiction is a disease; co-occurring mental health conditions should be addressed, and patients deserve respect, not judgement. Symetria Recovery provides comprehensive substance abuse treatment with a focus on Medication-Assisted Treatment (MAT) in a welcoming outpatient setting. Unlimited clinical services are available to our patients under our bundled-service delivery model. Key services delivered through our Opioid Treatment Program (OTP) licensure include MAT, medically monitored psychiatric care, individual therapy, group therapy (IOP), 6-day-per-week nursing care, and ongoing aftercare. Most of our patients being provided medication receive Buprenorphine products, but they can also receive Methadone, and any other FDA-approved medication for addiction.

Requirements

Ability to work effectively in a constantly changing environment, good judgment, and capable of making decisions with attention to detail.
Excellent organizational skills and ability to prioritize and coordinate workload with high degree of proficiency and accuracy.
Strong analytical and problem-solving skills, with the ability to locate and analyze VOB and UR trends
Ability to work collaboratively with other departments and inquire about questions or discrepancies when appropriate
Ability to work independently and follow through on tasks with minimal direct supervision
Excellent interpersonal communication skills
History of working in healthcare environment, with a minimum preference of 2 years’ experience
Strong understanding of end-to-end revenue cycle
Proven appeals and denial resolution experience

Responsibilities

Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to and/or resolving appeals with third-party payers in a timely manner.
Works closely with insurance companies to ensure proper review and processing of denied claims.
Identifies and tracks payer denials trends and works with the payers to correct any erroneous denials and works with the departments (i.e. Operations) to review and improve processes to avoid these denials in the future. This includes the review of documented coding guidelines.
Conducts relevant research to verify proper authorizations, contracted services and patient benefits.
Maintains data on the types of claims denied and root causes of denials and collaborates with team members to make recommendations for improvements and resolving issues.
Complies with State and Federal regulations, accreditation/compliance requirements, and policies, including those regarding fraud and abuse, confidentiality, and HIPAA. Maintains current knowledge of rules and regulations of third-party payers.
Communicate effectively with 3rd party RCM vendor.
Lead all reconsideration requests with insurance payers.
Assist with any assigned projects and analysis.