Denial Management Specialist
Denial Management Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
Northside Hospital is awardwinning stateoftheart and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.
Responsibilities
OCCUPATIONAL SUMMARY
Files written letters of appeal on claims denied by the insurance carriers. Performs extensive telephone contact with the insurance companies to conclude payment on the denied claims. Utilizes Northsides contract summaries to verify balances due on disputed claims.
PRIMARY DUTIES AND RESPONSIBILITIES
- Drafts written letters of appeal on various types of denied claims utilizing standard letters as well as customized letters depending on the denial.
- Utilizes/reviews account information from various sources; on line data hard copy reports referral forms UB92/itemized bills and EOBs to discuss account condition with the payer.
- Obtains information from Northsides contract summaries to negotiate reimbursement requirements of a claim.
- Refers accounts to appropriate departments for necessary action to be taken i.e. balance transfers electronic billing of accounts audit and coding reviews etc.
- Contacts insurance companies to follow up on appealed claims. Holds insurance company accountable for timely resolution of all appeals submitted.
- Maintains appropriate and accurate system documentation with notes and standard note codes allowing for appropriate extraction of denial data from the Denial database.
- Notifies Supervisor of payor trends in denied accounts.
Qualifications
KNOWLEDGE SKILLS AND ABILITIES/LICENSE OR CERTIFICATION REQUIRED
- B.S. degree or equivalent college courses in Health Science Bookkeeping or Business plus 3 years insurance collections/ AR receivables experience OR Associates degree plus 4 years experience in healthcare receivables or related field OR 5 years experience in healthcare receivables or related field
- Knowledge of healthcare receivables and collections including denial and appeal processes.
- Good verbal and written communication skills.
- Proficient calculator experience.
KNOWLEDGE SKILLS AND ABILITIES/LICENSE OR CERTIFICATION PREFERRED
- CPAR certification.
- Knowledge and experience with Excel.
- Experience with STAR McKesson products.
Work Hours:
Required Experience:
Unclear Seniority
Employment Type
Full-Time
