Denial Specialist Jobs

About The Position

Requirements

• High school diploma or equivalent (GED).
• At least two years of billing and insurance experience.
• Experience with email, the internet, and Microsoft Office products.
• Ability to read, write, and speak fluent English.
• Ability to communicate effectively with internal team members and external customers.
• Excellent organizational skills and ability to multitask and make quick, accurate decisions.
• Ability to communicate effectively and work independently.
• Manual dexterity to operate a computer and other office equipment, and ability to perform repetitive technology-related tasks.
• Ability to bend, stoop, kneel, or crouch as part of the job.
• Ability to lift and carry up to 25 pounds when necessary.

Nice To Haves

• Knowledge of CPT and ICD-10 coding, modifiers, and insurance specifications.

Responsibilities

• Work denied claims from the Denial Tickler and determine the action needed for resolution.
• Assess whether denials are justified, document findings, move balances to patient responsibility, or refer cases for adjustment or write-off approval.
• Prepare and submit appeals and understand each carrier’s appeal levels and processes.
• Contact insurance carriers by email, web inquiry, or phone to gather information.
• Correct and refile claims, including insurance policy IDs and prior authorization information; obtain certified coder approval for coding changes.
• Request insurance information, medical necessity documentation, records, or orders from ordering provider offices.
• Track timely filing and appeal deadlines and prioritize work accordingly.
• Track and communicate carrier-specific requirements and denial trends to Billing and Coding managers.
• Investigate outstanding claims in the tickler queue using carrier websites and phone contact, and address issues preventing processing.
• Provide credit balance information to the refund department when necessary.
• Provide payment posters with documentation to post insurance responses when appropriate.
• Assist patients with account inquiries by phone, mail, email, and voicemail.
• Process credit card payments in accordance with PCI requirements.
• Provide price quotes and billing expectations for upcoming appointments, including good faith estimates for self-pay or uninsured patients.
• Set up reasonable payment plans and help patients execute payment methods.
• Work with clinic staff to answer billing and balance inquiries in patient-facing clinics.
• Review electronic claim rejections, research rejection messages, make necessary changes, and rebill services.
• Review pre-eligibility checks and verify that suggested charges are appropriate.
• Review return mail from patients and insurance companies and act according to protocols.
• Review, document, distribute, resolve, and scan miscellaneous incoming mail and fax correspondence.
• Review health insurance claim forms (CMS-1500/UB-04) and attachments for accuracy.
• Scan and index documentation into the document management system.
• Collaborate with billing office colleagues to complete billing processes timely and efficiently.
• Attend staff meetings and education workshops or training.
• Report problems related to staffing, morale, work methods, and procedures to the Billing Manager.
• Perform other duties as assigned.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• Short-term disability insurance
• Long-term disability insurance
• Paid time off
• Paid holidays
• 401(k) retirement plan
• Referral program