Denial Specialist
Denial Specialist
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Salary Not Disclosed
1 Vacancy
Job Description
Our Mission: Quality compassionate care for all.
Our Vision: Reimagine health care through connection service and innovation.
Our Core Values: Be Kind Trust and Be Trusted Work Together Strive for Excellence.
Join Our Patient Accounting Team at Logan Health!
Location: Kalispell Gateway Community Center
Schedule: Day Shift 8 Hours Full-Time 40 Hours
Logan Health is seeking a detail-oriented and proactive Denial Specialist to join our Patient Accounting team. This critical role focuses on identifying and resolving insurance claim denials to secure accurate reimbursement and reduce financial loss. If you have strong problem-solving skills a working knowledge of medical billing and a passion for improving healthcare outcomes we want to hear from you!
What Youll Do:
Analyze and resolve denied insurance claims to ensure timely and accurate reimbursement.
Submit retro-authorization appeals and documentation in accordance with payer guidelines.
Research Explanation of Benefits (EOBs) and payer communications to determine denial causes and next steps.
Coordinate the submission of medical records appeal letters and supporting documentation via payer portals fax or mail.
Identify trends in denials and escalate systemic issues to leadership for resolution.
Collaborate with internal teams to update patient account information and resubmit claims when necessary.
Maintain accurate and thorough documentation of all appeal actions in internal systems.
Communicate professionally and promptly with payers internal departments and other stakeholders.
Basic Qualifications:
1 year(s) of experience in a hospital or medical office setting preferably in billing collections or insurance follow-up.
Skilled with basic accounting principles and ten-key by touch.
Proficient in Microsoft Office Suite especially Excel and can quickly learn new systems.
Strong critical thinking organizational and communication skills.
Thrive working both independently and collaboratively in a fast-paced environment.
Understand and adhere to HIPAA and confidentiality guidelines.
Preferred Qualifications:
Experience in denials management insurance claims processing or appeal writing.
Familiarity with CPT ICD-10 and HCPCS coding.
Ability to work efficiently within payer portals and understand payer-specific submission requirements.
Why Join Logan Health
Collaborative and mission-driven team culture.
Opportunity to make a direct impact on our revenue cycle and patient care experience.
Flexible scheduling options such as 4x10s are available for the right candidate.
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Qualifications:
Minimum of one (1) year experience in a hospital or medical office setting preferred.
Proficient with basic accounting and ten-key by touch preferred. Prior experience with business mathematical tasks and correspondence preferred.
Excellent interpersonal and customer service skills with the ability to manage sensitive and confidential situations with tact professionalism and diplomacy.
Possess and maintain computer skills to include working knowledge of Word Outlook Excel and ability to learn other software as needed. Proficiency in Excel preferred.
Possess ability to maintain confidentiality and understand HIPAA guidelines and other applicable federal laws.
Excellent organizational skills detail-oriented a self-starter possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
Commitment to working in a team environment and maintaining confidentiality as needed.
Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.
Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact professionalism and diplomacy.
Possess and maintain computer skills to include working knowledge of Microsoft Office Suite and ability to learn other software as needed.
Job Specific Duties:
Analyzes and interprets account data to facilitate timely claim and payment resolution as applicable to assigned area(s). Collaborates and/or refers unresolved issues and escalates to appropriate party.
Posts payments and adjustments utilizing the appropriate fee schedule policy and/or procedures in accordance with patient statements remittance advices insurance carriers electronic downloads etc. and as applicable to assigned area(s).
Identifies credits variances and trends. Performs appropriate action to facilitate resolution in a timely manner.
Documents all communication both written and verbal in an accurate clear and factual manner.
Completes account maintenance review to ensure account information is accurate within billing system.
Acts as a Patient Accounting liaison between patients clients providers payers vendors and other Logan Health departments as applicable to assigned area(s).
Interprets explanation of benefits (EOB) message codes validates payer processing and identifies potential payment discrepancies as applicable to assigned area(s).
Effectively manages assigned work in accordance with team expectations department productivity and quality standards and as applicable to assigned area(s).
Provides exceptional customer service to stakeholders for questions and concerns.
Responsible for all Medicare Medicaid and Case Management insurance denials processing as applicable to assigned area(s).
Responsible for all insurance appeals and works with appropriate stakeholders to ensure completion as applicable to assigned area(s).
Serves as point of contact for quotes equipment authorization etc. as applicable to assigned area(s).
The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge skills and abilities required for the job. Not all of the duties may be assigned to a position.
Maintains regular and consistent attendance as scheduled by department leadership.
Shift:
Day Shift - 8 Hours (United States of America)Location: Kalispell Gateway Community Center
Schedule: Day Shift 8 Hours Full-Time 40 Hours
Flexible scheduling options such as 4x10s are available for the right candidate
Logan Health operates 24 hours per day seven days per week. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.
Notice of Pre-Employment Screening Requirements
If you receive a job offer please note all offers are contingent upon passing a pre-employment screening which includes:
Criminal background check
Reference checks
Drug Screening
Health and Immunizations Screening
Physical Demand Review/Screening
Equal Opportunity Employer
Logan Health is an Equal Opportunity Employer (EOE/AA/M-F/Vet/Disability). We encourage all qualified individuals to apply for employment. We do not discriminate against any applicant or employee based on protected veteran status race color gender sexual orientation religion national origin age disability or any other basis protected by applicable law. If you require accommodation to complete the application testing or interview process please notify Human Resources.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
