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Denial Management Specialist

4 months ago

Sioux Falls, United States Twin Cities Orthopedics Full time

The Denial Management Specialist is responsible for efficiently working accounts receivable for the organization.

This is a full-time position working remotely M-F from 8:00 am - 4:30 pm. At least two years of previous billing or revenue cycle experience required.

Revo Health is a professional services company that partners with multiple healthcare groups to deliver exceptional patient care. This position will be employed by Revo Health, working closely with Infinite Health Collaborative (i-Health) and its operating divisions. We have a comprehensive Medical, Dental & Vision Plan, Maternity Bundle, 401K with Profit Sharing, Tuition Reimbursement, Gym & Car Rental Discounts and more.

Essential Functions:

* Ensure professional communication with patients, clinic personnel, and outside vendors over the phone, via email or other written documentation and respond to all inquiries
* Maintain a working knowledge of health care plan requirements and health plan networks
* Verify and document insurance information as defined by current business practices
* Accurately post all payments received from patients, attorney offices and/or insurance companies
* Review Explanation of Benefits (EOB), research denials, rejections and/or excessive reductions
* Ensure appropriate forms are used when requesting adjustments, insurance transfers or other specific account changes
* Prepare, submit and ensure timely claim accuracy for all physician billing to third party insurance carriers either electronically or via hard copy
* Make outbound phone calls to patients or insurance companies as follow up to unpaid, denied or rejected billing claims and document according to current policy
* Take inbound calls from patients or insurance companies as follow up to unpaid, denied or rejected billing claims and document according to current policy
* Review and work any credit balances to determine if patient and/or insurance company refund is applicable
* Any and all other duties as assigned

Education and Experience Requirements:

* High School diploma/GED or equivalent
* Previous experience in a healthcare facility in relation to accounts receivable or billing practices

Essential Requirements:

Ability to:

* Comply with company policies, procedures, practices and business ethics guidelines.
* Complete job required training.
* Comply with all applicable laws and regulations, (e.g. HIPAA, Stark, OSHA, employment laws, etc.)
* Demonstrate prompt and reliable attendance
* Work in the office during business hours
* Travel independently throughout the office (which may include movement from floor to floor); frequent bending, lifting, standing, stooping or sitting for long periods of time may be required
* Work at an efficient and productive pace, handle interruptions appropriately and meet deadlines
* Communicate and interact in a respectful and professional manner
* Prioritize workload while being flexible to meet the expectations of the daily operations
* Apply principles of logical thinking to define problems, establish facts, and draw valid conclusions
* Understand and execute a variety of instructions
* Effectively operate equipment and communicate on and operate the phone system
* Work independently with minimal supervision
* Travel to other work locations, if required

Performance Expectations - Revo Health's Core Values:

* Integrity - Do the right thing and take responsibility for what you do and say
* Service - Consistently contribute to deliver an exceptional experience
* Quality - Act with high purpose, committed effort, and skillful execution to exceed expectations
* Innovation - Identify progressive solutions that improve service, teamwork, efficiency, and/or effectiveness
* Teamwork - Be a part of the whole; support each other positively

Environmental Conditions:

* Office setting

Notes:

* Revo Health is an Equal Opportunity/Affirmative Action Employer and will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990 and the ADA Amendments Act of 2008.
* This position description will be reviewed periodically as duties and responsibilities change. Essential and Additional Job Functions are subject to modification.

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