Denials Management Specialist
Required skills
- High School Diploma
- GED
- Patient Accounting
- Patient Access
- Denial Management
- Third-Party Payer
- appeals
- payer edits
- rejections
Nice to have
- Associate's Degree
- Claim Audits
- Retro Authorization
- A/R clean-up
Role summary
The Denials Management Specialist is responsible for the timely and accurate follow-up and appeal of denials and rejections from third-party payers. This role involves managing assigned work independently to meet payer appeal/filing deadlines and achieve optimal payment. Key responsibilities include monitoring denial queues, investigating denial trends, assisting with claim audits, and writing non-clinical appeals. The specialist must possess knowledge of payer edits, rejections, and rules to ensure resolution. A High School Diploma or GED with 7 years of Patient Accounting or Patient Access experience, or an Associate's Degree with 3 years of such experience, is required.
Position Summary:
The Denials Management Specialist is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The specialist will work independently while managing their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered.
Essential Functions and Responsibilities as Assigned:
1. Monitors denial work queues and reports in accordance with assignments from direct supervisor. Maintains required levels of productivity while managing tasks in work queues to ensure timeliness of follow-up and appeals.
2. Tracks and investigates denial trends/ root cause.
3. Assists with claim audits as necessary.
4. Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.
5. Obtain retro authorizations and submit to payers for reimbursement.
6. Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.
7. As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.
8. Works independently with other departments to resolve A/R and payer issues.
9. Participates in departmental and team meetings involving discussion of A/R processes and trends.
10. Knowledge of payer edits, rejections, rules, and how to appropriately respond to each to resolution.
Qualifications:
Required:
- High School Diploma or GED
- 7 years experience in Patient Accounting or Patient Access experience
OR
- Associates Degree with 3 years of Patient Accounting or Patient Access experience
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