Denial Specialist

Job Description

Job Description

ESSENTIAL FUNCTIONS

• Review for appropriate insurance requirements (i.e. modifiers)
• Review of patient demographics (address, telephone #, guarantor changes, etc.) and insurance (certificate #, new primary or secondary coverage, etc.

for accuracy and completeness

• Ensure provider information is correct
• Once claims have been processed by the insurer, resolve any claim rejections or denials
• Review all ERAs (Electronic Remittance Advice) by line item to ensure patient balances are correct, the correct contractual adjustments have been done according to contracts, and the claims are in the correct status within the practice management system
• Process refunds based on the protocol of the applicable insurer . Review and manage the insurance aging analysis for the insurers
• Submit appeal / reconsideration requests to insurers
• Follow up on appeal / reconsideration requests
• Report denial trends to the Billing Supervisor

JOB REQUIREMENTS

• High school diploma or GED required
• One to three years of accounts receivable experience (preferably in Health Care) preferred
• CPC (Certified Coding Professional) preferred
• Knowledge of accounts receivable practices and medical billing office procedures
• Knowledge of insurance reimbursement procedures and practices
• Ability to work effectively with co-workers as a team member
• Ability to maintain the confidentiality of patient information in accordance with company policy & procedure, and HIPAA regulations.
• Ability to communicate effectively and clearly
• Must be able to work quickly and accurately
• Excellent critical thinking skills
• Effective interpersonal communication skills (written and verbal) to deal with sensitive situations
• Ability to work effectively with co-workers as a team member
• Ability to communicate effectively and clearly
• Must be able to work quickly and accurately
• Organization, time management and prioritization abilities
• Proficiency in Microsoft Office suite (Word, Excel, Outlook, and PowerPoint) is required as well as the ability to quickly learn and retain knowledge of how to use the electronic medical record.
• Proficiency with Windows based computer applications
• Ability to work autonomously and collaboratively with team members, including cross coverage to achieve the overall objectives of the department and organization
• Ability to demonstrate and uphold InterMed’s Values

InterMed is an equal opportunity workplace and prohibits discrimination or harassment of any kind. We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, gender identity and / or expression, sexual orientation, marital status, disability, veteran status, or any other basis protected by applicable federal, state or local law.