Denials Specialist, RCM

About the Role

This Specialist will join the claims follow-up team and be responsible for processing insurance company remittances, denial follow-up, and other tasks related to insurance claim accounts receivable. The Revenue Cycle Management (RCM) team is looking for someone with insurance claims denials follow-up experience, plus critical thinking skills, attention to detail, and the ability to learn quickly and adapt to a changing environment.

• High School Diploma required
• Two years' experience in healthcare administration/revenue cycle
• CRCR Certification preferred

• Excellent customer service
• Empathy and strong interpersonal communication
• Problem‑solving, prevention, and decision‑making skills
• Ability to manage and prioritize multiple tasks in a fast‑paced environment
• Excellent oral and written communication skills
• Composure and calmness in stressful situations
• Judgment and diplomacy with colleagues and payers
• Tendency to work collaboratively as part of a team
• Computer proficient and quick to learn new software
• Can work with minimal supervision

The purpose of this position is to execute follow‑up actions on insurance claims; expedite positive cash flow, maximize reimbursement, and resolve claims denials and issues with payers in the assigned area of the Revenue Cycle claims process.

• Help develop & maintain a corporate culture that supports the mission and values of Mayfield Clinic
• Follow up on submitted electronic & hard‑copy claims in an accurate, timely manner; submit appeals, make corrections to overturn denials, post payments, & process takeback requests as required.
• Correct claims that do not pass billing edits/payer requirements & resubmit to payers.
• Contact payers regarding unpaid claims and research questions and requests for information to ensure resolution & reimbursement.
• Ensure timely & accurate posting of remittance advice information & follow up as needed for full, expected reimbursement.
• Maintain documentation and update the practice management system for appropriate claims submission & other pertinent information to identify action taken.
• Make necessary adjustments as appropriately required by plan reimbursement & company policy.
• Prioritize claims based on aging and outstanding dollar amounts or as directed by management.
• Research & initiate requests for refunds for accounts with credit balances.
• Answer & initiate phone inquiries regarding bills, charges, claims, and account status.
• Update data in the practice management system as required.
• Contribute to the team environment by performing other duties as assigned.

• Hand movement: repetitive motions, grasping, holding, finger dexterity; reading & writing; hand–eye coordination; vision including color distinction; hearing; talking; sitting; lifting up to 10 pounds; bending; reaching.

• Superior clinical outcomes
• Compassionate patient care
• Education and research
• Innovation

• Integrity: honest & ethical behavior in all endeavors and interactions.
• Excellence: highest level of performance & continuous improvement.
• Respect: embracing and valuing diverse backgrounds, skills & contributions.
• Compassion: being compassionate & empathetic in all interactions.
• Collaboration:
  
  teamwork, mentoring, cooperation, sharing of expertise & empowerment.

Entry level

Full‑time

Strategy/Planning and Information Technology;
Medical Practices