The Denials Management Specialist is responsible for validating dispute reasons, escalating payment variance trends or issues to management, and generating appeals for denied or underpaid claims.
This role resolves complex and aged accounts through research of payer and governmental regulations, billing rules, payment activity, medical records, managed care contracts, and chargemaster details. The specialist provides feedback and recommendations to Managed Care, Revenue Integrity, and leadership teams, and collaborates with other departments to reduce ongoing denials and underpayments.
The position also requires accurate and thorough documentation of all collection activity performed and may include other duties within the scope of the role.
Education
- High school diploma or equivalent required
- Associate degree or higher preferred
Experience
- Minimum of 3 years of experience in a hospital business or medical office environment performing billing and/or collections
Certifications
- CRCR or CPAR certification preferred
Skills and Knowledge
- Excellent knowledge of MS Office and relevant computer software
- Strong team leadership, organization, interpersonal, and customer relations skills
- Strong analytical and problem-solving ability
- Ability to meet strict deadlines and manage multiple tasks simultaneously
- Ability to remain calm in difficult situations
- Strong written and oral communication skills
- Proficient computer skills
- Knowledge of ICD-9, ICD-10, and CPT coding
Location
Alabama, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago