Denials Specialist, RCM

Mayfield Clinic•Cincinnati, OH

1d•Onsite

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.

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

Nice To Haves

CRCR Certification preferred

Responsibilities

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.