Denial Management Specialist
Denial Management Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
Under general supervision this position is responsible for the receipt investigation and creation of the data record for medical necessity audits and denials. Reviews referrals for appropriateness and gathers information necessary for assigning appeal to appropriate clinical team. Contacts vendors insurance companies and other departments regarding appeal status and utilization review activity. Coordinates the preparation and posting of appeal packets.
Key Responsibilities
- Create and update denial tracking records consistently and thoroughly throughout the appeals process.
- Research denials to obtain a complete and accurate picture of the payers evaluation and what led to a denial.
- Proactively seek out denial correspondence that originates from various sources both internal and external to the Central Business Office (CBO).
- Appropriately assigns denials to clinical team.
- Prints medical record scans correspondence and prepares appeal packet.
- Establishes and maintains communication with immediate team CBO team affiliate hospitals UR department vendors and payers to assist in resolving issues impacting appeals and recovery of denied revenue.
- Shares information with the team and leadership to ensure the integrity of the denial information identify performance improvement opportunities and supports the clinical teams ability to prioritize triage and overturn denials.
Qualifications :
Education
- High School Diploma or equivalent (GED)
- Experience
- Two years work experience in 1) denials/appeals processing or utilization review; 2) collection or accounts receivable follow up; or 3) tech/medical secretary in acute care setting
Preferred
Education
- Associates Degree
- Experience
- Three-to-five years experience in denials/appeals processing.
Additional Information :
All your information will be kept confidential according to EEO guidelines.
Compensation
- Pay Range: $19.5-$27.31
- Other Compensation (if applicable):
- Review the 2024-2025 UMMS Benefits Guide
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Remote Work :
No
Employment Type :
Full-time
Employment Type
Full-time
