Denial Management Specialist
1 month ago
We are seeking a highly skilled Denial Management Specialist to join our team at Nationwide Credit & Collection Inc. in Oak Brook, IL.
Job Summary:
The Denial Management Specialist will be responsible for investigating insurance denials, analyzing EOBs, and correcting claims based on denials and rebilling using payor-approved processes.
Key Responsibilities:
- Investigate insurance denials to identify necessary actions to resolve claims
- Analyze EOBs at a claim level
- Correct claims based on denials and rebill using payor-approved processes
- Determine need for payor appeal of a claim and send appeals via payor portal or payor-approved appeal letters
- Monitor appeals for resolution
- Adjust accounts appropriately using correct denial codes
- Recognize when additional assistance is needed to resolve denials and escalate appropriately
- Spot trends and report them to management
- Work a minimum of 45 accounts per day with 95% accuracy
- Communicate effectively both verbally and in writing
- Detail all activities and findings in accordance with established policies and procedures
Requirements:
- High school graduate or equivalent
- 2 years previous experience in medical revenue cycle
- Minimum 1 year EPIC enterprise experience
- Familiarity with Excel
- Demonstrated problem-solving ability
- Able to work effectively in a remote setting
- Strong organizational skills
Preferred Qualifications:
- 2 years previous experience in medical denial management
- Minimum of 1-year recent Epic experience with the Resolute/Billing module
- Knowledge and experience in working with healthcare insurance portals
- A good understanding of CPT, modifiers, HCPC, ICD-10, and medical terminology
- Working knowledge of Medicare, Medicaid, and Commercial payor fee schedules and reimbursement documentation
- Good computer/tech knowledge (saving and locating files in OneDrive, Outlook, Excel)
Skills:
- Ability to effectively prioritize and execute tasks
- Ability to grasp and apply information quickly and accurately
- Ability to make decisions based on available information and within scope of their authority
- Excellent customer service skills and telephone interaction skills
- Excellent keyboarding skills, typing, and 10-key
- Proficiency with MS Word and Excel
- Good work ethic
About Us:
We are a 55-year-old family-owned accounts receivable firm located in Oak Brook, IL, that assists Hospitals and Physicians with their accounts receivables.
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