Medical Claims Denial & Appeals Specialist

CU Medicine•Aurora, CO

1d•$25 - $33•Remote

About The Position

University of Colorado Medicine (CU Medicine) is the region’s largest and most comprehensive multi-specialty physician group practice. The CU Medicine team delivers business operations, revenue cycle and administrative services to support the patients of over 4,000 University of Colorado School of Medicine physicians and advanced practice providers. These providers bring their unparalleled expertise at the forefront of medicine to deliver trusted, compassionate health care services at primary and specialty care clinics as well as facilities operated by affiliate hospitals of the University of Colorado. We are seeking a highly motivated Medical Claims Denial & Appeals Specialist to join our Accounts Receivable Resolution team. This job can be performed 100% remotely and out of state candidates will be considered.

Requirements

3-5 years experience in medical practice billing with exposure to working with denials, appeals, insurance collections and related follow-up.
ICD-10 and CPT coding assessment skills.
Intermediate PC software experience.
Advanced verbal and written communication skills.
Solid understanding and ability to apply contract language in conjunction with a comprehensive understanding of claims denial appeal logic.

Nice To Haves

Bachelor’s degree in a related field is strongly preferred.
CPC certification is preferred.

Responsibilities

Resolving all insurance claim denials for assigned departments to enhance revenues for CU Medicine providers.
Generating effective written appeals to carriers using well-researched logic.
Independently accountable for the denial resolution for their assigned divisions.
Appealing denials through coding review, contract review, medical record review and carrier interaction.
Demonstrating a high level of expertise in the management of complicated denied claims.
Deploying an analytical approach to resolve denials and recognize trends/patterns in order to proactively resolve recurring issues.
Utilizing a multitude of resources to ensure correct appeal processes are followed.
Communicating identified denial patterns to management.
Prioritizing and processing a large volume of denials and maintaining a high quality of work.
Serving as an escalation point for unresolved denial issues.
Informing team members of payer policy changes.
Assisting in training new employees as assigned.
Collaborating on special projects as needed.