Denials Management Specialist

6 days ago


MagstattleBas, Grand Est, United States Methodist Health System Full time
About the Role

We are seeking a highly skilled and detail-oriented Denials Management Specialist to join our team at Methodist Health System. As a key member of our revenue cycle team, you will be responsible for reviewing and resolving denials for commercial and government payers, as well as physician and facility claims.

Key Responsibilities
  • Denial Review and Resolution: Analyze denials compared to applicable contract agreements, payer medical policy language, and NMHS coding and authorization processes.
  • Contract and Reimbursement Analysis: Research contractual and reimbursement issues and answer inquiries from internal and external sources.
  • Claims Resolution and Follow-up: Correctly handle denials, resolve issues in a timely manner, and follow up on appeals and other related matters.
  • Collaboration and Communication: Assist staff with work volume as needed, respond to special requests with accurate information, and provide contract and payer recommendations.
  • Payer Meetings and Training: Participate in payer meetings, escalate payer issues, and provide training on contracts and reimbursement to other areas as needed.
Requirements
  • Education: High School Diploma or General Educational Development (G.E.D.) required; college coursework in accounting and/or healthcare preferred.
  • Experience: Minimum 1-2 years of experience working for a 3rd party payer or healthcare provider required; minimum 1 year of insurance billing experience preferred.
  • Skills and Knowledge: Proficiency in Microsoft Office, including Word, Excel, and Outlook; ability to perform 10-key data entry; skill with verbal and written communication; knowledge of medical terminology, patient accounting software, and payer websites.
About Methodist Health System

Methodist Health System is a leading healthcare provider in Nebraska and southwest Iowa, with a commitment to delivering exceptional care to our communities. We offer a comprehensive benefits package, competitive pay, and a supportive work environment that values our employees' contributions.



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