Denials Specialist

CGH Medical Center

1d•$17 - $25•Onsite

About The Position

This position supports the denial management team by reviewing claims for root causes for all types of denials, as well as proposing process improvements to mitigate future denials. Tracks and trends why denials are occurring and communicates information along with recommendations for improvement to the Denials Manager. Represents CGH Medical Center in a positive professional manner, educating the physician, staff and community on various issues pertaining to denial management.

Requirements

High School Diploma or equivalent required.
Extensive knowledge of reimbursement systems; federal, state and payer-specific regulations and policies pertaining to hospital and physician documentation, coding, and billing.
Computer literacy including Microsoft applications required.
Excellent communications, customer service and organizational skills required.

Nice To Haves

Associates degree preferred.
Current coding certification preferred.
AAHAM Certified Revenue Cycle Specialist preferred.

Responsibilities

Performs retrospective and prospective account reviews to ensure accurate reimbursement.
Processes each denial appropriately to resolution including but not limited to contacting and rebilling insurance, requesting medical records, compiling an appeal letter, and account statusing.
Analyzes denials to identify trends and root causes.
Develops suggestions for process improvements, based on denial analysis.
Distills data into clear reports to denial management leadership.
Partners with denial management leaders to develop and implement process improvements.
Proactively maintains current knowledge of applicable regulations, requirements, changes, and best practices by following industry sources.
Develops and maintains relationships with all revenue-generating departments, third party payers, attorneys, denial management partners, and patients.
Maintains expertise in the financial management system and the electronic billing software.