Denials Management Specialist

Company: Southwoods Health

Location: Boardman, Ohio

Schedule: Full-time. Monday-Friday 8am-4:30pm.

Southwoods Health is hiring a Denials Management Specialist
. In this role, you will be responsible for corresponding with insurance carriers regarding aged, unpaid claims. The ideal candidate will work diligently to secure and expedite payments through proactive follow-up and the strategic appeals resolution process.

• Worklist Management:
  Review tasks, credit balances, and denial worklists on a daily and weekly basis.
• Payer Correspondence:
  Contact insurance companies directly to determine the status of unpaid or denied accounts, and navigate online insurance websites efficiently.
• Documentation & Appeals:
  Prepare, file, and submit formal insurance appeals. Send necessary copies or supporting clinical documentation required by insurance carriers.
• Account Logging:
  Detailed note-taking of all contact interactions with insurance companies and patients within the patient’s account records.
• Claims & Resolutions:
  Mail insurance claim forms with required attachments, investigate insurance credit balances for resolution, and identify/report billing errors to the supervisor for policy corrections.
• Industry Compliance:
  Review insurance newsletters and websites regularly for policy updates. Ensure all processes maintain strict compliance with regulatory agencies (OSHA, ODH, BOP, TJC, etc.).

• Education/Training:
  Completed training or courses in business office operations, computer applications, and medical terminology.
• Certification:
  Collection or billing certification is highly preferred.
• Core Knowledge:
  Comprehensive knowledge of operational aspects of the revenue cycle and proven measures to take in successfully resolving complex claim issues.
• Key
  
  Skills:
  
  Effective communication skills, professional problem-solving capabilities, and the ability to maintain a professional demeanor at all times backed by strong ethical principles.

At Southwoods, it's not just about the treatment, but how you're treated. Join our award-winning team today.

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