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Clinical (Claims) Denial Specialist

4 months ago

Galesburg, United States Bridgeway Full time
Job DescriptionJob Description

Bridgeway is hiring a Clinical (Claims) Denial Specialist at our Galesburg, IL location.

The Clinical Denial Specialist performs work related to clinical claim denial. The individual is responsible for handling claim denials related to referral, authorizations, notifications, non-coverage, medical necessity, and others as assigned.

To learn more about this position, please read below a list of summarized duties.

  • Research payer claim denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, billing resulting in denials and delays in payment.
  • Creates and submits appeal letters.
  • Submits detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party
  • Submits retro-authorizations in accordance with payer requirements in response to authorization denials.
  • Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.
  • Review payer communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements.

Minimum requirement is an Associate's Degree in business or healthcare related field. Must have three (3) years of experience in a healthcare revenue cycle or clinic operations role and one (1) year in claim-related appeal writing.

In lieu of degree, must have five (5) years or more experience in healthcare revenue cycle or clinic operations and claim-related writing.

Employment with Bridgeway is conditional upon completion of all background checks.

Bridgeway is an Equal Opportunity Employer.

It is the objective of Bridgeway to make Equal Employment Opportunity (EEO) a reality for all employees and qualified applicants without regard to sex, sexual orientation, gender identity, national origin, ancestry, age, race, religion, marital status, physical or mental disability or unfavorable discharge from military services and to prevent sexual harassment in employment.