Denials Specialist, RCM

Mayfield Clinic•Cincinnati, OH

11d

About The Position

This Specialist will join the claims follow-up team and be responsible for processing insurance company remittances, denial follow-up, and other tasks related to insurance claim accounts receivable. The Revenue Cycle Management (RCM) team is looking for someone with insurance claims denials follow-up experience, plus critical thinking skills, attention to detail, and the ability to learn quickly and adapt to a changing environment. Education/Experience: High School Diploma required Two years' experience in healthcare administration/revenue cycle CRCR Certification preferred Skills: Demonstrates excellent customer service Ability to convey empathy Strong problem-solving, problem-prevention, and decision-making skills Ability to manage and prioritize multiple tasks in fast-paced environment Excellent oral and written communication skills Ability to maintain composure and restore calm in a stressful situation Uses good judgment and diplomacy when dealing with others Desire and ability to work in a team environment Computer proficient with the ability to learn multiple software applications Ability to work with minimal supervision Primary Responsibilities: The purpose of this position is to execute follow-up actions on insurance claims; expedite positive cash flow, maximize reimbursement, and resolve claims denials and issues with payers in the assigned area of the Revenue Cycle claims process. Essential Functions: Help develop &maintain a corporate culture that supports the mission and values of Mayfield Clinic Follow up on submitted electronic & hard copy claims in an accurate, timely manner; submit appeals, make corrections to overturn denials, post payments, & process takeback requests as required. Make all necessary corrections to claims that do not pass billing edits/payer requirements & resubmit to payers. Contact payers regarding unpaid claims. Research and/or ensure that questions and requests for information are addressed in a timely & professional manner to ensure resolution & reimbursement. Ensure timely & accurate posting of remittance advice information & follow up as needed to ensure full, expected reimbursement for services provided. Maintain documentation and update our practice management system for appropriate claims submission & other pertinent information to identify action taken. Make necessary adjustments as appropriately required by plan reimbursement & company policy. Prioritize claims based on aging and outstanding dollar amounts or as directed by management. Research & initiate requests for refunds for accounts with credit balances. Answer & initiate phone inquiries regarding bills, charges, claims, and account status. Update data in the practice management system as required. Contribute to the team environment by performing other duties as assigned. Physical Requirements: Hand Movement, including repetitive motions, grasping, holding, and finger dexterity. Reading, Writing, and Hand-Eye Coordination. Vision, including color distinction, and visual inspection. Hearing, Talking, Sitting, Lifting up to 10 pounds, Bending, Reaching Mayfield Clinic Mission: To provide the best neurological care for our patients through: Superior clinical outcomes Compassionate patient care Education and research Innovation Mayfield Clinic Values: All associates who are affiliated with the Mayfield Clinic must agree to use these values as a basis for their employment, and recognize that they are part of the associates annual Performance Review and Development Plan: Integrity: We commit to honest and ethical behavior in all of our endeavors and interactions. Excellence: We commit to the highest level of performance and continuous improvement. Respect: We embrace the importance of all individuals & value their diverse backgrounds, skills & contributions. Compassion: We commit to being compassionate and empathetic in all of our interactions. Collaboration: We embrace teamwork, mentoring, cooperation, sharing of expertise, & empowerment.

Requirements

High School Diploma required
Two years' experience in healthcare administration/revenue cycle
Demonstrates excellent customer service
Ability to convey empathy
Strong problem-solving, problem-prevention, and decision-making skills
Ability to manage and prioritize multiple tasks in fast-paced environment
Excellent oral and written communication skills
Ability to maintain composure and restore calm in a stressful situation
Uses good judgment and diplomacy when dealing with others
Desire and ability to work in a team environment
Computer proficient with the ability to learn multiple software applications
Ability to work with minimal supervision
Hand Movement, including repetitive motions, grasping, holding, and finger dexterity.
Reading, Writing, and Hand-Eye Coordination.
Vision, including color distinction, and visual inspection.
Hearing, Talking, Sitting, Lifting up to 10 pounds, Bending, Reaching

Nice To Haves

CRCR Certification preferred

Responsibilities

Follow up on submitted electronic & hard copy claims in an accurate, timely manner; submit appeals, make corrections to overturn denials, post payments, & process takeback requests as required.
Make all necessary corrections to claims that do not pass billing edits/payer requirements & resubmit to payers.
Contact payers regarding unpaid claims.
Research and/or ensure that questions and requests for information are addressed in a timely & professional manner to ensure resolution & reimbursement.
Ensure timely & accurate posting of remittance advice information & follow up as needed to ensure full, expected reimbursement for services provided.
Maintain documentation and update our practice management system for appropriate claims submission & other pertinent information to identify action taken.
Make necessary adjustments as appropriately required by plan reimbursement & company policy.
Prioritize claims based on aging and outstanding dollar amounts or as directed by management.
Research & initiate requests for refunds for accounts with credit balances.
Answer & initiate phone inquiries regarding bills, charges, claims, and account status.
Update data in the practice management system as required.
Contribute to the team environment by performing other duties as assigned.