Denial Specialist

3 months ago


Tampa, United States SNI Companies Full time
The Denials Specialist performs advanced-level work related to clinical and coding denial management and appeals follow-up
The individual is responsible for conducting a comprehensive review of the insurance denial and working with the Clinical Denials Nurses and Coding Denials Specialists to compile appropriate documentation and medical records to submit appeals or corrected claims in a timely manner
This position applies prior knowledge of denials to assess and ensure services/items billed are reasonable and necessary, supported by national/local coverage determinations and commercial medical policies
Additionally, this position will actively manage, maintain and communicate denial / appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Leadership
This position anticipates and responds to a wide variety of issues/concerns
The Denials Specialist works independently to plan, schedule and organize activities that directly impact hospital and physician reimbursement
This role is key to securing reimbursement and minimizing organizational write offs.
Responsibilities/Job Description:
  • Formulates strategy for prioritizing cases and maintains aging within appropriate ranges with minimal direction or intervention from Leadership
  • Reviews account history, remit, payer history, and state requirements to determine appropriate challenge and appeal strategy
  • Gathers and fill out all special appeal or payer required forms
  • Composes and submits all required documentation (including appropriate medical records to support medical necessity) for a reconsideration, appeal, or retro authorization to the insurance carrier via payer portal, fax, etc...
  • Documents and summarizes all rationale for all appeals in EPIC
    Documents communications with medical office staff and/or MD provider as required
  • Follows up on submitted appeals through payer portal or phone calls to the payer
  • Escalates issues in accordance with the department escalation policy
    Uses critical thinking skills to resolve aged and problematic accounts
  • Follows account to timely resolution to include appropriate financial adjustment
  • Interfaces with other departments to satisfactorily resolve issues related to appeals and initial denials
  • Communicates with Pre-Cert team and/or medical office personnel to obtain pertinent information
  • Maintains a thorough understanding of operations and business unit processes/workflows including, but not limited to authorizations and referral requirements, and in/out-of-network insurances
  • Maintains payer portal access and utilizes said portals to assist in reviewing commercial medical policies or LCD and NCD (local and national coverage determination) rules
    Maintains a current knowledge of CMS rules and regulations relating to the grievance and appeal processes
  • Maintains working knowledge of applicable insurance carriers' timely filing deadlines, claims submission processes, and appeal processes and escalates timely filing requests to Leadership
  • Collaborates with Clinical Denials Nurse, Coding Denials Specialists, and Leadership in high-dollar claim denial review
  • Monitors for denial trends, works collaboratively with the revenue cycle teams to reduce revenue loss
    Helps identify issues from denials and appeals that might be avoided on future claims
  • Assist department leadership with research, analysis and special projects
    Attends necessary payer meetings to escalate denials issues
  • Participate in huddle meetings and sharing the details of cases worked
Qualifications:
Required
  • Two years' recent experience in healthcare revenue cycle or prior authorizations for inpatient/outpatient, hospital/physician
  • Experience in healthcare claims processing and proficiency with medical billing and remittance forms and processes, including 835 and 837 files, and UB04 and CMS-1500 (HCFA) forms
  • Experience in managing and appealing authorization or medical necessity denials
  • Medical terminology

Get job alerts by email. Sign up now Join Our Talent Network

Job Snapshot
Employee Type Contract to Hire

Location Tampa, FL (Onsite)

Job Type Other

Experience Not Specified

Date Posted 07/27/2024

Job ID 382531

Remote No
  • Denial Specialist

    1 month ago


    Tampa, United States Accounting Now Full time

    The Denials Specialist performs advanced-level work related to clinical and coding denial management and appeals follow-upThe individual is responsible for conducting a comprehensive review of the insurance denial and working with the Clinical Denials Nurses and Coding Denials Specialists to compile appropriate documentation and medical records to submit...

  • Denial Specialist

    4 weeks ago


    Tampa, Florida, United States Accounting Now Full time

    Job Title: Denial SpecialistAt Accounting Now, we are seeking a highly skilled Denial Specialist to join our team. As a key member of our revenue cycle team, you will play a critical role in ensuring timely and accurate reimbursement for our clients.Key Responsibilities:Denial Management: Conduct comprehensive reviews of insurance denials and work with...


  • Tampa, Florida, United States SNI Companies Full time

    Job Title: Clinical Denials SpecialistJob Summary:We are seeking a highly skilled Clinical Denials Specialist to join our team at SNI Companies. As a Clinical Denials Specialist, you will be responsible for conducting a comprehensive review of insurance denials and working with our Clinical Denials Nurses and Coding Denials Specialists to compile appropriate...


  • Tampa, Florida, United States SNI Companies Full time

    Job Title: Denial SpecialistAt SNI Companies, we are seeking a highly skilled Denial Specialist to join our team. As a Denial Specialist, you will play a critical role in managing and appealing authorization or medical necessity denials, ensuring timely resolution and minimizing revenue loss.Key Responsibilities:Denial Management: Formulate strategies for...


  • Tampa, Florida, United States Accounting Now Full time

    Job Title: Clinical Denials SpecialistAt Accounting Now, we are seeking a highly skilled Clinical Denials Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for managing and appealing clinical denials to ensure accurate reimbursement for our clients.Key Responsibilities:Denial Management: Formulate strategies for...


  • Tampa, Florida, United States Sherloq Solutions Full time

    About Sherloq SolutionsSherloq Solutions is a leading provider of revenue cycle services, dedicated to delivering exceptional results in the healthcare industry. Our team is passionate about helping healthcare providers and payers maximize their revenue and improve patient outcomes.Job SummaryWe are seeking a highly skilled Medical Billing Specialist,...


  • Tampa, Florida, United States Sherloq Solutions Full time

    Job DescriptionSherloq Revenue Solutions is seeking a Medical Billing Specialist, Insurance Revenue Cycle to join our team. As a key member of our revenue cycle team, you will be responsible for resolving healthcare claims through verbal or online inquiries to health insurance payers.Key Responsibilities:Resolve healthcare claims through verbal or online...


  • Tampa, Florida, United States Sherloq Solutions Full time

    We are seeking a skilled Medical Billing Specialist to join our team at Sherloq Revenue Solutions. This full-time position is part of our Insurance Revenue Cycle department, where you will play a crucial role in resolving healthcare claims and ensuring accurate billing and reimbursement.Key Responsibilities:Resolve healthcare claims through verbal or online...


  • Tampa, Florida, United States Sherloq Solutions Full time

    Job DescriptionSherloq Revenue Solutions is seeking a highly skilled Medical Billing Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for resolving healthcare claims through verbal or online inquiries to health insurance payers.Key ResponsibilitiesEffectively navigate and utilize various healthcare provider...


  • Tampa, Florida, United States Tampa General Hospital Full time

    This position reports directly to the Revenue Cycle Manager at Tampa General Hospital in a role that has several distinct functions. The Finance and Revenue Cycle Program Specialist will drive strategic process improvement, manage complex projects, and solve difficult problems. The Finance and Revenue Cycle Program Specialist will demonstrate project...


  • Tampa, Florida, United States CarepathRx Full time

    Job Title: Escalations Collections SpecialistCarepathRx is seeking a dedicated and detail-oriented Escalations Collections Specialist to join our Revenue Cycle Team. In this role, you will be responsible for resolving escalation requests for the collections of insurance claims.Key Responsibilities:Ensure the timeliness and accuracy of escalation requests and...


  • Tampa, Florida, United States AdventHealth Full time

    Job SummaryWe are seeking a highly skilled Senior Account Specialist to join our team at AdventHealth. As a key member of our revenue cycle team, you will be responsible for processing insurance and reimbursement collection efforts in a timely manner.Key ResponsibilitiesReview and analyze electronic claims and submission reports to ensure accurate and timely...


  • Tampa, Florida, United States Surgery Partners Full time

    Job Title: Medical Billing ClerkUniversal Spine and Joint Specialists is seeking a skilled Medical Billing Clerk to join our team in Tampa, FL.Job Summary:The Medical Billing Clerk will be responsible for assisting the Billing department with various tasks, including answering phone calls, scanning documents, and reviewing claims before submission.Key...

  • Billing Specialist

    1 week ago


    Tampa, Florida, United States North Coast Medical Supply LLC Full time

    About the PositionThe Billing Specialist is responsible for ensuring timely and accurate submission of claims through clearinghouse. This role requires a high level of attention to detail and efficiency, with a focus on clearinghouse rejection management.Key ResponsibilitiesManages high volumes of claims with exceptional speed and accuracy.Reviews and...


  • Tampa, United States Tampa General Hospital Full time

    This position reports directly to the Revenue Cycle Manager at USF Tampa General Physicians (USFTGP) in a role that has several distinct functions. The Finance and Revenue Cycle Program Specialist will drive strategic process improvement, manage complex projects, and solve difficult problems. The Finance and Revenue Cycle Program Specialist will demonstrate...


  • Tampa, Florida, United States Orthopaedic Solutions Management Full time

    Job SummaryWe are seeking a highly skilled Revenue Cycle Specialist to join our team at Orthopaedic Solutions Management. As a key member of our revenue cycle team, you will play a critical role in ensuring timely collection of accounts receivable and maximizing reimbursement for our ancillary billing.Key ResponsibilitiesResearch and resolve claims denials...


  • Tampa, Florida, United States Surgery Partners Full time

    Job Summary:Universal Spine and Joint Specialists is seeking a Medical Billing Clerk to assist the Billing department with various tasks. The ideal candidate will have excellent computer skills and be able to work independently with minimal supervision.Duties and Responsibilities: Review and process claims for accuracy and completeness Correct and resubmit...


  • Tampa, Florida, United States Tampa General Hospital Full time

    Job SummaryWe are seeking a highly skilled Financial Operations Specialist to join our team at Tampa General Hospital. This role will play a critical part in driving strategic process improvement, managing complex projects, and solving difficult problems within our Revenue Cycle department.Key ResponsibilitiesDrive strategic process improvement initiatives...


  • Tampa, Florida, United States Orthopaedic Solutions Management Full time

    Job SummaryWe are seeking a highly skilled Revenue Cycle Specialist to join our team at Orthopaedic Solutions Management. As a key member of our revenue cycle team, you will be responsible for managing the flow of medical claims and ensuring timely payment from insurance carriers.Key Responsibilities:Manage and resolve denied claims in a timely and efficient...


  • Tampa, United States Accounting Now Full time

    We are hiring Revenue Cycle Specialists who excel in Medicare Collections for our Revenue Operations DepartmentSpecialists in this role will contact Medicare Administrative Contractors (MACs) to reconcile outstanding accounts receivable (debit balances), research and resolve problem accounts, and request adjustments or rebills on claims. Duties: Research,...