Denial Management Specialist Lead

4 weeks ago

Rochester, United States HarmonyCares Full time

OverviewHarmonyCares is one of the nation’s largest home-based primary care practices. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home. This includes HarmonyCares, HarmonyCares Medical Group, HarmonyCares Home Health and HarmonyCares Hospice.Our Mission – To bring personalized, quality-based healthcare to the home of patients who have difficult accessing care.Our Shared Vision – Every patient deserves access to quality healthcare.Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. Empower and support each other.Why You Should Want to Work with UsHealth, Dental, Vision, Disability & Life Insurance, and much more401K Retirement Plan (with company match)Tuition, Professional License and Certification ReimbursementPaid Time Off, Holidays and Volunteer TimePaid Orientation and TrainingGreat Place to Work CertifiedEstablished in 11 statesLargest home-based primary care practice in the US for over 28 years, making a huge impact in healthcare today ResponsibilitiesThe Denial Management Specialist Lead, CNC & Specialty Programs is responsible for the optimal payment of claims for Centene and Wellcare Payers, along with any other payers within the Health Risk Assessment and Value Based Care programs. Primary duties include but are not limited to: Consistently following up on unpaid, underpaid & denied claims utilizing weekly aging reports, biweekly A/R report distribution to staff, value-based encounter denial follow up, filing appeals when appropriate to obtain maximum reimbursement, establish and maintain strong relationships with payers, monitor trends in denials and payment changes. Works closely with department manager to communicate claims issues to Specialty Programs Operations Team, Centene and Health Risk Assessment Teams. This position will be responsible for leading the team to resolve problems, as well as working with other departments on reimbursement challenges. (This person will need to live in or near Troy, MI and go into the office; specifically on Thursdays- once a week for collaboration meetings).Essential Duties & ResponsibilitiesAssist in facilitating training and onboarding experience for new hiresAssist in creation/maintenance of Standard Operating ProceduresResponsible for cross-training current team members or specialized training for projectsPoint of contact for issue resolution with the departmentCollaborate with other Revenue Cycle Management departments or Operational teams to resolve issuesAssist in Compiling Productivity and Quality MeasuresReview Claims failed on Front End Edits due to various reasons; analyze the root causeReview and analyze insurance claims/encounters both in aged and denied AR for HarmonyCares Value Based and Centene plansAccess denied claims from the worklist and query claim status with the payor, utilizing all appropriate systems & websites to effectively research the claim and resubmit or appeal as necessaryResolve for root cause denial reasons, reduce denial trending and communicate trends to managementAssist the team in prioritizing claims based on aging and outstanding dollar amounts, or as directed by managementLearn and understand internal/external operating systems to help staff navigate obstacles, including but not limited to: Centricity, EDI, Waystar, Various Insurance portalsRegularly meet with supervisor to discuss challenges or billing obstacles as well as to provide status of outstanding aging reportsAssist Management in submission and monitoring of Invoices to various plans through various processesVery strong MS Product background report heavy- Pivot tables- able to create Excel formulas. QualificationsRequired Knowledge, Skills and ExperienceHigh School diploma or equivalent5+ years of insurance follow up experience in a healthcare insurance environment and ability to multitaskComputer experience is essential, including but not limited to: Microsoft products, with a heavy focus on MS Excel, Pivot Tables, PowerPoint, and SharePoint Ability to use critical thinking skills for troubleshooting staff questions/issuesKnowledge of multi-specialty physician billing procedure guidelines according to Medicare, Medicaid, Commercial, and third-party payer policies and basic understanding of medical terminology, ICD and CPT codesKnowledge of value-based care modelExperience in filing claim appeals with different payers to ensure maximum entitled reimbursementAbility to perform mathematical computationsSkill in defining problems, collecting data and interpreting billing informationAdditionally, the ability to work effectively with staff, patients, public and external agenciesGood customer service and telephone techniques required as well as a high level of confidentiality Preferred Knowledge, Skills and ExperienceAssociates degreeCertification in Medical Billing/CodingCertified Revenue Cycle Representative (CRCR) Posted Min Pay Rate USD $25.68/Yr. Posted Max Pay Rate USD $31.18/Yr. Pay TransparencyIndividual compensation packages are based on various factors unique to each candidate, including skill set, experience, qualifications, and other job-related considerations. NoticeHarmonyCares and HarmonyCares Hospice are not affiliated with Harmony Hospice Care. HarmonyCares Hospice does not conduct business in OH. HarmonyCares Hospice conducts business in MI, VA, WI, TX, IN, IL.

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