PATH BEHAVORIAL HEALTHCARE

CRITERIA-BASED JOB DESCRIPTION

TITLE: DENIAL MANAGEMENT

RESPONSIBLE TO: SR DIRECTOR OF RCM 

WORK AREA:

SUMMARY

This position is responsible to resolve aged accounts and must have denial management 

experience.  Must have OUTPATIENT MENTAL HEALTH Revenue Cycle Management experience. 

Professional communication skills are required for interaction with colleagues, payors and 

management. This is a remote position (work from home) with set hours Monday-Friday. Must 

be able to work independently.  

PRIMARY JOB DUTIES 

• Denial management research and determine claim denials and take appropriate action for payment within federal, state, and payor guidelines  

• Trend Identification - Identify consistent payor or system trends that result in underpayments, denials, errors, etc.  

• Ability to understand and navigate payor guidelines  

• Determine and escalate claim issues with payor when appropriate  

• Meet with leadership to discuss/resolve reimbursement and/or payor obstacles  

• Appeals - Determine when an appeal, reopening, redetermination, etc. should be requested and the requirement of each insurance carrier  

• Outstanding balances - Take appropriate action to resolve claim  

• Claim status - Use available resources such as payor portals and clearinghouses to review unresolved accounts  

• Unapplied payments - Identify unapplied payments and take appropriate action to resolve account.  

• Phone calls - Call appropriate payors or patient to obtain the information necessary to resolve the claim.  

• Medical insurance policies - Knowledge and understanding of current policies and procedures required to determine claim resolution  

• Coordination of Benefits- Ability to review eligibility response and determine payor sequence.   

• Knowledge of all payor benefits, including Medicaid, and liability guidelines  

• Secondary follow up as needed  

• Communication clear and concise communication both written and verbal, including documenting all activities associated with an account  

• Production and Quality Standards must meet company standards and ability to work in fast paced environment  

• Other responsibilities as assigned

QUALIFICATIONS:  

• Education: Associates degree strongly preferred, or a minimum of 3 years’ experience in quota-based medical reimbursement field  
• Experience/Skills: Minimum 3 years’ experience in high volume or quota-based billing environment.  
• Physical Effort: Requires working under stressful conditions or working irregular hours.  
• Interpersonal Skills: *Excellent, professional interpersonal skills in dealing with patients, providers, and coworkers.  
• Ability to read and understand EOB, EOP, RAs in all aspects (paper, electronic and ANSI files)   
• Excel, Word skills, PDF skills   
• Experience with MS Teams and channels  
• Experience in billing 1500 forms. Understanding of non-contracted (OON) and contracted payer behaviors  
• Knowledge of medical terms  
• Candidate must be able to provide documentation to support ability to work in the United States within the federal legal guidelines.

WORK FROM HOME REQUIREMENTS  

• Must have reliable and secure equipment  
• Must have high speed internet  
• APPLICANT CAN BE ANYWHERE IN OHIO
• Experience, Organization, Communication, Time consciousness, Proactiveness, Tech Savvy, Motivation, and Balance

We are an equal opportunity employer and do not discriminate in hiring or employment on the basis of race, color, religion, national origin, citizenship, gender, gender identity, genetic information, marital status, sexual orientation, age, disability, veteran status, or any other characteristic protected by federal, state, or local law.