The Denial Management Specialist is responsible for denial and accounts receivable management for the department as defined by their supervisor/manager.
- Research and resolve outstanding denials within the work queue and complete all necessary follow-up in a timely and accurate manner.
- Identify denial trends and provide education on steps to prevent future avoidable denials.
- Initiate and manage insurance appeals in a timely manner.
- Manage outstanding accounts receivable related to denials.
- Communicate denial trends and increases to the direct supervisor/manager to help reduce denial volume.
- Organize workflow to ensure denials are worked according to departmental policy and standards.
- Manage correspondence and ADR requests according to department workflow procedures to ensure timely and accurate responses.
- Complete special projects as assigned by the supervisor/manager.
- Prepare for and attend AR denial meetings as required.
Requirements & Qualifications
Minimum Requirements
Education
- High school diploma or equivalent
Experience
- 4 years of experience in medical billing, with exposure to denials, appeals, insurance collections, and related follow-up
- Good knowledge of ICD-9 and CPT-4 coding
- Strong working knowledge of insurance explanation of benefits (EOBs)
- Comprehensive understanding of remittance and remark codes
- Familiarity with multiple payer requirements for claims processing
- Solid Microsoft Office skills, especially Excel and Word
- Strong communication skills
Licensure / Certification
- Not required
Preferred Qualifications
- Associate's or Bachelor's degree in a healthcare-related field
- Focused denials and appeals management experience
- CPC and/or CPC-H certification
Location
South Carolina, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 month ago
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