Denials Management Specialist

McLaren Health Care•Shelby Township, MI

About The Position

The Denials Management Specialist is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The specialist will work independently while managing their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered.

Requirements

High School Diploma or GED
7 years experience in Patient Accounting or Patient Access experience
Associates Degree with 3 years of Patient Accounting or Patient Access experience

Responsibilities

Monitors denial work queues and reports in accordance with assignments from direct supervisor. Maintains required levels of productivity while managing tasks in work queues to ensure timeliness of follow-up and appeals.
Tracks and investigates denial trends/ root cause.
Assists with claim audits as necessary.
Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.
Obtain retro authorizations and submit to payers for reimbursement.
Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.
As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.
Works independently with other departments to resolve A/R and payer issues.
Participates in departmental and team meetings involving discussion of A/R processes and trends.
Knowledge of payer edits, rejections, rules, and how to appropriately respond to each to resolution.