DUTIES
Researches and analyzes denial data and coordinate denial recovery responsibilities.
Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials
Develop reporting tools that effectively measure and monitor processes throughout the denials management process in order to support process improvement.
Prioritizes activities to work overturns in a timely manner to alleviate untimely filings
Uses reports that categorize denials to assign tasks or personally work to overturn denials
Identifies and pursues opportunities for improvements in denial performance
Processes work lists to facilitate prompt intervention of insurance denials
Researches, responds, and documents insurer and patient correspondence/inquiry notes regarding coding coverage, benefits, and reimbursement on patient accounts
Researches rejections included in EOBs for resolution and files appropriately
Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks
Helps with coverage for the Financial Counselor.
QUALIFICATIONS
• Demonstrated understanding of medical terminology required • Knowledge of patient confidentiality and HIPAA regulations • Knowledge of CPT, HCPCS, and ICD10 coding required. • Knowledge of medical billing and collection practices • Understands Medicare and Medical Assistance regulations as they apply to job functions • Knowledge working with electronic health records (EHR/EMR) or healthcare related computer systems • Excellent written and verbal skills are required as well as outstanding interpersonal skills • Practices efficient methods for getting work done; strong ability to prioritize workload • Organized; sets priorities; meets deadlines • Ability to work independently.