Denial Resolution Specialist

4 weeks ago


Atlanta Georgia, United States Northside Hospital Inc. Full time
Job Summary

Northside Hospital Inc. is seeking a highly skilled Denial Management Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for resolving denied claims and ensuring timely payment from insurance carriers.

Key Responsibilities
  • Draft and submit written appeals for denied claims, utilizing standard and customized letters as needed.
  • Review and analyze account information from various sources, including online data, hard copy reports, and EOBs, to discuss account conditions with payers.
  • Utilize contract summaries to negotiate reimbursement requirements and resolve disputes.
  • Refer accounts to appropriate departments for necessary action, such as balance transfers, electronic billing, and audit reviews.
  • Follow up with insurance companies to ensure timely resolution of appealed claims and maintain accurate system documentation.
  • Monitor and report payor trends in denied accounts to management.
Requirements
  • Bachelor's degree in Health Science, Bookkeeping, or Business, or equivalent college courses, plus 3 years of insurance collections/AR receivables experience.
  • Associate's degree, plus 4 years of experience in healthcare receivables or a related field.
  • 5 years of experience in healthcare receivables or a related field.
  • Knowledge of healthcare receivables and collections, including denial and appeal processes.
  • Excellent verbal and written communication skills.
  • Proficient calculator experience.
Preferred Qualifications
  • CPAR certification.
  • Knowledge and experience with Excel.
  • Experience with STAR and McKesson products.


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