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Patient Accounts Denial Specialist

4 months ago

Rockford, United States Rockford Gastroenterology, Assc., LTD Full time
Job DescriptionJob DescriptionDescription:

OVERALL SUMMARY:

Our Patient Accounts Department is seeking a skilled Denial Specialist to join our revenue cycle management team. The Denial Specialist plays a crucial role in analyzing and resolving insurance claim denials to ensure optimal reimbursement for medical services provided.

  • Review and analyze denied insurance claims to identify the reasons for denial.
  • Research and understand insurance policies, coding guidelines, and billing regulations to support claim appeals.
  • Prepare and submit appeal letters and supporting documentation to insurance companies.
  • Collaborate with medical coders, billing staff, and clinicians to gather necessary information for appeals.
  • Monitor appeal status and follow up with insurance companies to expedite claim resolution.
  • Identify trends in claim denials and recommend process improvements to minimize denials.
  • Maintain accurate records of denial appeals, outcomes, and reimbursement.
  • Other Duties determined by Manager.

Key Competencies:

  • Problem-solving skills to identify root causes of claim denials.
  • Ability to prioritize tasks and manage multiple appeals simultaneously.
  • Team player with a collaborative approach to work.
  • Adaptability to changing insurance policies and billing requirements.
  • Strong organizational skills to maintain detailed appeal records.


Requirements:

QUALIFICATIONS:

A. Healthcare Administration, Business, or related field (or equivalent work experience).

B. Minimum of 2 years' experience in medical billing, claims processing, or denial management.

C. Familiarity with insurance verification, authorization, and appeals processes.

D. Strong analytical skills and attention to detail.

E. Excellent communication and negotiation abilities.

F. Proficiency in using billing software and electronic health records (EHR) systems.

G. Work at RGA office at 401 Roxbury Road in Rockford, IL 61107.