Position SummaryThe Denial Management, Revenue Cycle Specialist is responsible for analyzing, tracking and resolving healthcare insurance denials to ensure optimal reimbursement and the financial stability of our clients.Essential Functions
- Reviews and analyzes insurance denials to determine root causes and implement effective resolution strategies.
- Collaborates with account managers, billing departments and insurance companies to resolve denied claims promptly.
- Maintains up-to-date knowledge of insurance policies, coding regulations, and compliance requirements to minimize denials.
- Tracks and documents denial activities to help identify opportunities for process improvements to reduce future claim denials.
- Utilizes detailed reports on denial trends, patterns and KPIs as generated by management.
- Maintains the highest level of privacy in accordance with HIPAA requirements and laws.
- Appeals denied claims by preparing and submitting necessary documentation and communicating with the insurance companies.
- Ensures timely and accurate follow-up on all outstanding denied claims.
- Contacts patients, payers, hospitals, attorneys, employers, and any other parties involved to collect the necessary information and ensure reimbursement for our client.
- Meets monthly company, team, and individual goals, and all deadlines set by the Manager, Denial Management.
- Completes special projects, as requested.
- Ability to maintain consistent and regular attendance in accordance with an established schedule.
- Ability to work onsite/in-office in accordance with CCS and department policies and procedures.
Qualifications
Minimum of 3 to 5 years of directly related industry experience.Proficiency in denial management systems, healthcare billing software and electronic health records (EHR).Experience with EPIC is required.Strong analytical skills with the ability to interpret complex data and generated actionable insights.Ability to interpret EOBs and knowledge of how to resolve denials.Excellent communication and interpersonal skills, with the ability work effectively with diverse teams.Detail oriented with strong organizational skills and the ability to manage multiple tasks simultaneously.Knowledge of medical terminology, coding (ICD-10, CPT) and insurance policies.Ability to speak confidently over the phone.Demonstrated knowledge of state laws and insurance statutes.Certifications preferred but not required:- Certified Professional Coder (CPC)
- Certified Coding Specialist (CCS)
- Certified Healthcare Financial Professional (CHFP)
- Coachable: receptive to feedback, willing to learn, embraces continuous improvement, and responsive to change.
Educational Requirements
- Bachelor's degree in Healthcare Administration, Business, Finance or related field preferred.
- Five (5) years of directly related experience in medical billing, coding or denial management within a healthcare setting in lieu of degree.