01Overview
Role Description
The Multispecialty Denials Specialist will review documentation and coding guidelines for profession fee-based coding, evaluation and management services, procedures, and diagnoses. This role involves researching claim denials, submitting appeals, following up on outstanding claims, and handling claims correspondence. This is a full-time remote employee opportunity.
Research payer denials related to referral, pre-authorization, eligibility/registration, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as clients policies and procedures.
Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
Demonstrate knowledge and understanding of insurance billing procedures as evidenced by the identification of root-causes of claim issues and proposed resolutions to ensure timely and appropriate payment.
Ensure appropriate revenue is captured; to prevent federal and payer audits, malpractice litigation, and health plan denials.
Qualifications
Proficiency with MS Office Suite and Athena software
Profee multispecialty, E/M coding: 2 years
Physician based Denials: 5+ years
(AAPC) CPC and/or (AHIMA) CCS, CCS-P, or RHIT certification
Knowledge of medical terminology, insurance and appeals processes, and medical record management
High level of accuracy and attention to detail
Strong written and verbal communication skills .
