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Denial Management Specialist

2 months ago

Kirkland, Washington, United States CSI Full time
Job Title: Denial Management Specialist

Career Opportunity at CSI Companies

Csi Companies is seeking a highly skilled Denial Management Specialist to join our team. As a Denial Management Specialist, you will be responsible for investigating health plan denials to determine appropriate action and provide resolution.

Key Responsibilities:
  • Investigate insurance denials to identify necessary action
  • Correct claims based on denials, complaints, and audits, and rebill using payor-approved processes
  • Determine the need for payor appeals and send individualized appeal letters, monitoring appeals for resolution
  • Adjust denials determined to be appropriate using corresponding adjustment codes
  • Work accounts that meet denial management criteria, coordinating resolution with other departments
  • Log all denials, including actions and resolution, on a denial spreadsheet
  • Identify denial patterns to identify potential process improvements
  • Produce quarterly denial reports
Requirements:
  • High school graduate or equivalent
  • College degree or vocational training in billing or business highly preferred
  • 1 year of previous experience in professional billing
  • Knowledge and experience working with healthcare insurers and their reimbursement systems, especially Medicare, Medicaid, Workers Compensation, Motor Vehicle, and contract payers
  • A good understanding of CPT, Modifiers, HCPC, ICD-10 codes, and medical terminologies
  • Demonstrated problem-solving ability
  • Ten-key by touch
  • Experience working with EMR systems, including EPIC or CERNER, highly preferred
About Us:

Csi Companies is a national workforce solutions firm established in 1994, awarded "Best of Staffing" for 5 years in a row. We provide comprehensive workforce solutions, including recruiting, technology, IT consulting, and staffing for leading businesses and Fortune 500 companies nationwide.

We offer a range of benefits, including weekly pay, medical, dental, and vision coverage, voluntary life and AD&D coverage, paid training, and opportunities for advancement upon performance and availability.