Central Denials Account Specialist

24 hours ago

Birmingham, Alabama, United States Guidehouse Full time
Job Summary:

The Central Denials Account Representative conducts thorough account reviews to determine the appropriate action needed to resolve the account balance. This includes reviewing and performing the following:

  • Electronic Files
  • 835 Electronic Files
  • UB04's and 1500 Claim Files
  • Medical Record
  • Making outbound calls to Insurance Companies to resolve claim denials and account balances.
  • Performing Non-Clinical Appeals.
  • Assisting Supervisor/Manager as needed with various projects.
  • Escalating payer issues/trends to a supervisor with the appropriate information or taking appropriate action so that the issue expert can effectively resolve the matter.
  • Communicating to Supervisor/Manager areas of concern or areas of improvement.
  • Resubmitting Corrected Claims and supporting documentation as needed for the patient experience.
  • Communicating with other organizational departments to ensure proper handling of patient accounts.
  • Communicating issues to management timely and performing other duties as assigned by direct supervisors.
  • Performing a variety of duties often changing from one task to another of a different nature without loss of efficiency or composure.
Requirements:

  • HS Diploma or equivalent.
  • 0-2 years medical provider experience working with UB04, appeals & denials.
Preferred Qualifications:

  • Basic computer skills.
  • Good written and verbal communications skills.
  • Ability to facilitate conversations with others and establish an understanding of the customer's issue/reason for contact.
  • Ability to perform essential job functions with a high degree of independence, flexibility, and creative problem-solving techniques.
  • Ability to interpret and apply reimbursement aspects of managed healthcare contracts.
  • Attentive listening skills.
  • Exceptional customer service skills including effective and efficient problem-solving and analyzing skills.
  • Ability to initiate and follow through on projects and work independently with minimal supervision required.
About Guidehouse:

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1- or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

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