Patient Account Denial Specialist - Patient Financial Services

Job Details

Support Services | Miamisburg | Full Time | Days

The Patient Accounts Denial Specialist is responsible for monitoring denials, appeals, takebacks, and resolutions from insurance carriers and working proactively to collect outstanding denied accounts. The job responsibilities and duties include: identifying, analyzing, and researching frequent root causes of denials and developing corrective action plans for resolution of denials. Position will be required to be detail-oriented and formulate appeals researching and analyzing denial data and coordinating denial recovery responsibilities.

Candidate will be required to be knowledgeable, understand, and apply critical thinking skills to the correct appeal methodology to help address various denials such as proving medical necessity and retro authorizations appeals. Specialist are required to apply the proper escalation of outstanding denials including submitting complaints to various agencies such as the Ohio Department of Medicaid and the Department of Insurance.

In addition to denials, employee will address pre and post takebacks by health plans that are required to be investigated and appropriate action taken. Specialist must prioritize activities to work overturns in a timely manner to alleviate untimely filings is a must. Working with Insurance payers to ensure proper billing takes place on all assigned patient accounts. Depending on payer contract may be required to participate in conference calls, accounts receivable reports, compiles the issue report to expedite resolution of accounts.

Works follow up report daily, maintaining established goal(s), and notifies Team Lead and/or Supervisor, of issues preventing achievement of such goal(s). Follows up on daily correspondence to appropriately work patient accounts. Assists Customer Service with Patient concerns/questions to ensure prompt and accurate resolution is achieved.

Produces written correspondence to payers and patients regarding status of claim, requesting additional information, etc. Initiates next billing, assign appropriate follow-up and/or collection step(s), this is not limited to calling patients, insurers, or employers, as appropriate. Sends initial or secondary bills to Insurance payers. Documents billing, follow-up and/or assign collection step(s) that are taken and all measures to resolve assigned accounts.

Escalation to Supervisor/Manager of any issues or changes in billing system, insurance carrier, and/or networks. Works other duties as assigned. Writing appeals on denials including pre and post takebacks. Contacting payer to acquire status of submitted appeal. Joining payer calls and participating to address issues.

High school Diploma or equivalent required.

Minimum of a year working denials in the healthcare setting. Experience in Microsoft tools, Epic EMR Experience (preferred), Relay Health/ePremis Experience (preferred).

• Experience with the Revenue Cycle – registration, medical records, billing, coding, etc.
• Experience with managed care contract terms and federal payer guidelines
• Experience with medical necessity guidelines and care coordination/case management functions
• Experience with hospital billing (UB92 form) and coding requirements