Denial Management Specialist

1 month ago

Oak Brook, United States Nationwide Credit & Collection Inc. Full time
Job DescriptionJob Description

Denial Management Specialist

Essential Job Functions

· Investigates insurance denials to identify action necessary to resolve the claim– including calls to payor use of multiple computer systems, e.g., Epic, insurance portal, clearing house, etc.

· Able to analyze EOBs at a claim level

· Corrects claims based on denials and rebills using payor approved processes

· Determines need for payor appeal of a claim and sends appeals via payor portal or payor appropriate appeal letters. Monitors appeals for resolution

· Adjusts accounts appropriately, using correct denial codes

· Recognizes when additional assistance is needed to resolve denials and escalates appropriately

· Spots trends and reports them to management

· Works a minimum of 45 accounts per day with 95% accuracy

· Communicates effectively both verbally and in writing

· Details all activities and findings in accordance with established policies and procedures.

· Performs special projects or other duties as assigned

· Maintains strictest confidentiality, adhering to all employer and government privacy standards, e.g., 42 CFR part 2 and HIPAA

· Maintains current knowledge of internal, industry and government regulations as applicable to denial management

Experience REQUIRED:

· High school graduate or equivalent

· 2 years previous experience in medical revenue cycle

· Minimum 1 year EPIC enterprise experience

· Familiarity with Excel

· Demonstrated problem solving ability

· Able to work effectively in a remote setting

· Strong organizational skills

Experience Preferred:

· 2 years previous experience in medical denial management

· Minimum of 1-year recent Epic experience with the Resolute/Billing module

· Knowledge and experience in working with health care insurance portals

· A good understanding of CPT, modifiers, HCPC, ICD-10 and medical terminology

· Working knowledge of Medicare, Medicaid and Commercial payor fee schedules and reimbursement documentation, e.g., payor rules, non-payable codes, etc.

· Good computer/tech knowledge (saving and locating files in OneDrive, Outlook, excel)

Skills:

· Ability to effectively prioritize and execute tasks

· Ability to grasp and apply information quickly and accurately

· Ability to make decisions based on available information and within scope of their authority

· Have excellent customer service skills and telephone interaction skills

· Excellent keyboarding skills, typing and 10 key

· Proficiency with MS Word and Excel

· Good work ethic

Company DescriptionWe are a 55-year-old family-owned accounts receivable firm, located in Oak Brook, IL, that assists Hospitals and Physicians with their accounts receivables. If you would like to further your career and join our successful teamCompany DescriptionWe are a 55-year-old family-owned accounts receivable firm, located in Oak Brook, IL, that assists Hospitals and Physicians with their accounts receivables. If you would like to further your career and join our successful team

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