Denial Management Specialist

Overview:

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Responsibilities:

OCCUPATIONAL SUMMARY

Files written letters of appeal on claims denied by the insurance carriers. Performs extensive telephone contact with the insurance companies to conclude payment on the denied claims. Utilizes Northside’s contract summaries to verify balances due on disputed claims.

1. Drafts written letters of appeal on various types of denied claims utilizing standard letters as well as customized letters depending on the denial.
2. Utilizes/reviews account information from various sources; on line data, hard copy reports, referral forms, UB92/itemized bills and EOBs to discuss account condition with the payer.
3. Obtains information from Northside’s contract summaries to negotiate reimbursement requirements of a claim.
4. Refers accounts to appropriate departments for necessary action to be taken i.e., balance transfers, electronic billing of accounts, audit and coding reviews, etc.
5. Contacts insurance companies to follow up on appealed claims. Holds insurance company accountable for timely resolution of all appeals submitted.
6. Maintains appropriate and accurate system documentation with notes and standard note codes allowing for appropriate extraction of denial data from the Denial database.
7. Notifies Supervisor of payor trends in denied accounts.

Qualifications:

REQUIRED:

1. a. B.S. degree, or equivalent college courses, in Health Science, Bookkeeping or Business, plus 3 years insurance collections/ AR receivables experience OR b. Associate's degree, plus 4 years experience in healthcare receivables or related field. OR c. 5 years experience in healthcare receivables or related field 2. Knowledge of healthcare receivables and collections, including denial and appeal processes. 3. Good verbal and written communication skills. 4. Proficient calculator experience.

PREFERRED:

1. CPAR certification. 2. Knowledge and experience with Excel. 3. Experience with STAR, McKesson products.

Work Hours:: 600AM-2:45PM