Denials Specialist

Job Description

Job Description

This role is responsible for the follow-up and collections of accounts on the accounts receivable. This includes general payer collections and denial follow-up. In addition, this rolecould oversee the intake of patient calls. This position performs various accounting, customer services and organizational tasks to promote the financial health of the organization.

The identification of Duties and Responsibilities does not display an exhaustive list of all duties that may be assigned to this position, nor does it restrict the related work that may be assigned to this position. ONLY THOSE QUALIFIED CANDIDATES THAT LIVE IN OH, MI, IL, GA WILL BE CONSIDERED

WHAT YOU WILL BE WORKING ON:

â- Accounts Receivable follow up, both collection and denials resolution

o Requires direct calling to payers and use of payer portals

â-ª Working in Patient Account system, work queuesand use of excel documents

â- Credit balance resolution

o Ability to interpret a variety of eobs to reconcile the patient account. Determining appropriate balance and actions needed to reconcile account to determine if credit is accurate and take appropriate action for refund/takeback

â- Place outgoing calls to insurance companies to resolve outstanding claims/balances

â- Working knowledge of Medicare, Medicaid, Government and Commercial payers

â- Ability to trend and communicate payer scenarios

â- Perform month end close procedures within established time frame

â- Communicate with Manager payer and account issues in a timely manner

â- Monitor accounts for other opportunities (i.e. copay, deductible and coinsurance)

â- Enter appropriate comments in the software system clearly and concisely for tracking and documentation

â- Ensure adherence to HIPAA standards and all other privacy and compliance policies

â- Staying knowledgeable on Payer/Contract updates and bulletins

â- Perform other duties as assigned to support the financial health of the organization

KNOWLEDGE, EDUCATION and SKILLS REQUIREMENTS:

â- High School diploma or equivalent

â- Previous Healthcare experience in Accounts Receivable Management

WHAT WILL MAKE YOU AWESOME:

â- Excellent written and verbal communication skills

â- Excellent computer skills, including Excel, Word, and RCM systems as needed.

â- Highly organized, detail-oriented, strong work ethic, and demonstrated teamwork skills

â- Ability to multi-task and meet deadlines

WHAT YOU KNOW:

To be successful in this role you will have the following experience or knowledge:

â- Ability to read various eobs

â- Payer Portals

â- Medicare/Medicaid Knowledge