Denial Management Specialist

Job description

Denial Management Specialist

U.S. Medical Management (USMM) is an affiliate of a leading Fortune 100 company. A national organization built on a continuum of care with premier healthcare providers, clinicians and patient focused individuals working together. Our Mission - "Through Compassionate Patient-Centered Care in the Home; We will Provide Exceptional Outcomes across our Continuum of Services" - Visiting Physicians Association, Pinnacle Senior Care, Grace Hospice, Comfort Hospice, Home DME & our In Home Health Assessments (IHA).

Our Values of Integrity, Respect, Teamwork & Excellence are leading us to a better tomorrow for patient care. Our Purposes Centered on "We are Unified in our Work through our Continuum of Services" "We can Find Comfort that We are Making a Difference for our Patients" & "We make a Broader Positive Impact on Society", allows USMM to be poised for a phenomenal future.

We are seeking candidates who desire the experience of delivering quality & compassionate healthcare within proven care models with patients at the forefront of everything we do.

Benefits We Have to Offer:

• Health, Dental, Vision, Disability & Life Insurance
• 401K Retirement Plan
• Paid Holidays
• PTO
• Flexible Spending Account
• Tuition Reimbursement
  

Position Description

The Denial Management Specialist is responsible for the optimal payment of claims from Medicare, Medicaid, BCBS, Commercial and Manage Care Plans; primary duties includes, but are not limited to: consistently follow up unpaid /denied claims utilizing monthly aging reports, filing appeals when appropriate to obtain maximum reimbursement and establish and maintain strong relationships with providers, clients and fellow staff, monitor trend in denials of payment changes.

Essential Duties and Responsibilities

• Reviews Claims failed on Front End Edits due to various reasons; analyzes the root cause by contacting Patients/ Payers / Inter Departments and Clearing House
• Works with inter department and other parties involved for lack of information that may be causing up front payer rejections, correct and submit clean claims
• Reviews and analyzes insurance claims with accounts receivable balances that have aged beyond 30 days old or claims denied in the Insurance Follow-Up Module, and A/R reports
• Accesses denied claims from the worklist and queries claim status with the payor, utilizing all appropriate systems, websites to effectively research the claim and resubmit or appeal as necessary
• Makes necessary arrangements for medical records requests, completion of additional information requests etc. as requested by insurance companies to ensure timely resolution of outstanding denied/unpaid claims
• Prioritizes claims based on aging and outstanding dollar amounts, or as directed by management
• Regularly meets with supervisor to discuss challenges or billing obstacles as well as to provide status of outstanding ageing reports worked

REQUIRED Knowledge, Skills and Experience

• High School Diploma or Equivalent
• Minimum of 2 years of insurance follow up experience in a healthcare insurance environment and ability to multi task
• Computer experience is essential, including but not limited to: practice management software, word processing and spreadsheet applications, and 10-key by touch
• Knowledge of multi-specialty physician billing procedure guidelines according to Medicare, Medicaid, Commercial, and third party payer policies and basic understanding of medical terminology, ICD 9 and CPT 4
• Experience in filing claim appeals with different payers to ensure maximum entitled reimbursement
• Ability to perform mathematical computations
• Skill in defining problems, collecting data and interpreting billing information
• Additionally, the ability to work effectively with staff, patients, public and external agencies
• Good customer service and telephone techniques required as well as a high level of confidentiality

Preferred Knowledge, Skills and Experience

• Certification in Medical Billing/Coding
• Two years of related experience