Denial Management Specialist Job in Wesley Chapel, Florida
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Job Title: Denial Management Specialist
|Employer:||Premier Heart and Vascular Center PA
|Type:||FULL TIME, OTHER
|Skills:||Denial management,EOB reconciliation
|Required Experience:||1 to 2 years
|Location:||27424 Cashford Circle Wesley Chapel 33544, FL, US
Under the general supervision of the Revenue Cycle Director, the Denials Management Specialist will be responsible for analyzing payer account reconciliation discrepancies and identifying variance causes for the identification and resolution of payer denials and expected reimbursement underpayments. Responsibilities include:
- Reviews and resolves accounts assigned via work lists daily as directed by management. Focuses on working complex denials across multiple payers and/or regions. Conducts account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching the payer remittance advice.
- Conducts follow up research on claims to review contract discrepancy and account balances. This may include attaching documentation, amending coverage/patient/encounter/provider/facility data, gathering additional information requests, and resubmitting corrected claims to ensure accurate and timely claim adjudication. Reviews explanation of benefits (EOB) or, if not present, calls the Payor to obtain claims status for denied claims
- Defends and appeals denied claims, including researching underlying root cause, collecting required information or documents, adjusting the account as necessary, resubmitting claims, and all appropriate follow up activities thereafter to ensure adjudication of the claim. Must also be comfortable communicating denial root cause and resolution to leadership as needed.
- Responsible for aggregating the data that is required and then sending complete appeal packets for every level of appeal either by mail, fax or Federal Express utilizing the denials management tool.
- Identifies system loading discrepancies within the contract management system and refers to the Supervisor, Contract Manager or Contract Administrator for correction.
- Adhering to Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.
- Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
- High school diploma or equivalent
- 1+ years’ experience in billing, A/R follow up and/or denials management & appeal writing
- Basic understanding of an explanation of benefits (EOB)
- Basic knowledge of CPT, ICD-10, and HCPCS coding standards