Job Description Summary

Denial management specialist is responsible for reviewing and researching all billing denials that have been received from the payor. This would include identifying the root cause of the denial and providing denial resolution in a timely manner.



Essential Responsibilities

· Reviews and researches claims in which a denial payment has been received from the payer in a timely manner.

· Manages and Develops necessary department and executive level reporting

· Identifies the root cause of the denial and addresses the denial issue with the appropriate department (i.e. Billing, CDM, Clinical Documentation, Coding, etc.)

· Utilizes all appreciate systems to effectively research claims and complete steps to submit information necessary to process or appeal claims

· Investigates and ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims

· Completes and requests adjustments to a claim, as appropriate, based on the dollar threshold of the adjustment

· Reviews, works and reports all claims that have aged more than the specified grace period stipulated in policies and / or contacts

· Organizes work/ resources to accomplish objectives and meet deadlines

· Demonstrates problem- solving skills related to denial analysis

· Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively to obtain necessary information to address denial management issues

· Meets productivity requirements to ensure excellent service is provided to customers

· Maintains compliance with established corporate and departmental policies and procedures

· Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, customers and co-workers

· Identify all denial trends and provide education of steps to prevent future avoidable denials.

· Initiate/Manage all appeals in a timely manner.

· Organize the work flow to ensure that denials are worked according to timely filing deadlines and conditions of payment.

· Communicate all denial trends and denial increases to direct supervisor in order to positively affect the volume of denials.

· Building relationships with payors.

· Complete special projects as assigned by Supervisor/Manager.



Position Requirements

· High School Diploma required; Bachelor’s Degree preferred

· At least 3-5 years of experience in revenue cycle and/or billing experience

· Denial Management and/or electronic billing experience are preferred

· Highly motivated individual with attention to detail in fast paced environment

· Good internal/external customer communication skills required

· Able to work independently and collaboratively as a team player

· Systems include Excel, Power Point, Zirmed billing system