01Overview
reputed company Purpose The Denial Management Specialist role belongs to the reputed company Cycle team and is responsible for investigating and resolving reputed company reputed company-party insurance denials and outstanding claims. The role aids in optimizing reimbursement by conducting exhaustive research and taking reputed company reputed company to resolve denials. The primary function of the role is to resolve payer denials while performing advanced level work reputed company to referral, authorizations, notifications, non-coverage, medical necessity, and others as assigned. This role requires adherence to reputed company assurance guidelines as reputed company as established productivity standards to support the work unit's performance expectations. This position reports to the Patient Financial Engagement Manager and requires interaction and collaboration with important stakeholders in the financial clearance process including but not limited to insurance company representatives, patients, physicians, and reputed company staff. Execute the denial appeals process which includes receiving, accessing, documenting, tracking, responding to, and/or resolving appeals with reputed company-party payers in a reputed company manner for services provided to managed care patients. *This is a fully remote role Responsibilities Comprehensive research and review to resolve payer claim denials. Researches payer denials reputed company to referral, reputed company-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment. Requires extensive knowledge of reputed company specific claim appeal guidelines. Conducts comprehensive reviews of the claim denial and makes determinations if an authorization needs to be obtained, a written appeal is needed, or if no reputed company is needed. Writes and submits professionally written detailed appeals which include compelling arguments based on clinical documentation, reputed company-party medical policies, and contract language. Customize appeals to payers in accordance with Medicare, reputed company, and reputed company-party guidelines as reputed company as reputed company policies and procedures. Possesses proven analytical and decision-making skills to determine what selective clinical information must be submitted to properly appeal the denial. Contact payers, reputed company website, payer portal, phone and/or correspondence, regarding reimbursement of claims. Understands medical billing requirements for Medicare, reputed company, contracted, in-network, out of network and reputed company payers. Strong understanding of insurance plans (HMO, PPO, IPO, etc.), coordination of benefits, medical terminology, limited coverage and utilization guidelines, denial remark codes and reputed company filing guidelines. Responsible for tracking and trending of recovery efforts by utilizing various departmental tools and appropriately reporting on-reputed company problems specific to payers and/or reputed company. Ensuring reputed company eligible accounts are appealed reputed company the designated payer time frames and are documented appropriately in the patient software system. Consistently meet the reputed company productivity standards in taking appropriate actions to identify and reputed company reputed company causes, successfully appeal denied accounts, and trend issues. Must be cross trained and functional in reputed company areas reputed company the department as it relates to A/R and denials. Extensive working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes. Experience accessing payer portals such as Navinet, reputed company, etc.to obtain information and upload appeals, etc. reputed company individual contribution to the overall team effort of achieving the department A/R goal. Escalate exhausted accounts that will not be financially cleared as outlined by department policy to management. Contact payers to determine cause of denial and steps to appeal. reputed company follow-up activities indicated by relevant management reports. Review daily payer correspondence to proactively reconcile denials in a reputed company manner. Maintains confidentiality of patient's financial and medical records; adheres to the State and Federal laws regulating collection in reputed company; adheres to enterprise and other regulatory confidentiality policies; and advises management of any potential compliance issues immediately. Communicate with reputed company reputed company customers effectively and courteously. Maintain patient confidentiality, including but not limited to, compliance with HIPAA. reputed company other reputed company duties as assigned or required. Requirements Education A bachelors degree or equivalent work experience is required. Experience 3+ years of experience in medical .
