Denials Management Specialist

Position Summary

The Denials Management Specialist is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The specialist will work independently while managing their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered.

• Monitors denial work queues and reports in accordance with assignments from direct supervisor. Maintains required levels of productivity while managing tasks in work queues to ensure timeliness of follow-up and appeals.
• Tracks and investigates denial trends/ root cause.
• Assists with claim audits as necessary.
• Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.
• Obtain retro authorizations and submit to payers for reimbursement.
• Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.
• As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.
• Works independently with other departments to resolve A/R and payer issues.
• Participates in departmental and team meetings involving discussion of A/R processes and trends.
• Knowledge of payer edits, rejections, rules, and how to appropriately respond to each to resolution.

• High School Diploma or GED
• 7 years experience in Patient Accounting or Patient Access experience

OR

• Associates Degree with 3 years of Patient Accounting or Patient Access experience

• Schedule:
  
  Full-time
• Requisition :
• Daily Work Times: 8am - 4:30pm
• Hours Per Pay Period: 80
• On Call:
  No
• Weekends:
  No