Denial Management Specialist; Medical Billing Job Kirkland area,Washington USA,Healthcare

Position: Denial Management Specialist (Medical Billing)

Wage Range: $21.09 - $33.75 per hour

Hybrid in Washington State only - Medical Billing

Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.

Job Summary

Investigates health plan denials to determine appropriate action and provide resolution.

Primary Duties

Investigates insurance denials to identify action necessary.

Corrects claims based on denials, complaints, and audits and rebills using payor approved process.

Determines need for payor appeal and sends individualized appeal letter. Monitors appeals for resolution.

Adjusts denials determined to be appropriate using the corresponding adjustment code(s).

Works the accounts that meet denial management criteria and coordinates resolution with other departments. Denial management criteria include accounts that have potential financial impact such as authorization and refer denials, bundling issues and medical necessity for all assigned payers.

Logs all denials including actions and resolution on Denial spreadsheet.

Identify denial pattern to identify potential process improvement.

Produces quarterly denial reports.

License, Certification, Education or Experience REQUIRED for the position

High School graduate or equivalent.
1-year previous experience in professional billing.
Knowledge and experience in working with health care 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.

DESIRED for the position

College degree/Vocational training in billing or business.

Benefit Information

Choices that care for you and your family

Medical, vision and dental insurance
On-demand virtual health care
Health Savings Account Flexible Spending Account
Life and disability insurance
Retirement plans (457(b) and 401(a) with employer contribution)
Tuition assistance for undergraduate and graduate degrees
Federal Public Service Loan Forgiveness program
Paid Time Off/Vacation
Extended Illness Bank/Sick Leave
Paid holidays
Voluntary hospital indemnity insurance
Voluntary identity theft protection
Voluntary legal insurance
Pay in lieu of benefits premium program
Free parking
Commuter benefits

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