Patient Account Denial Specialist -Patient Financial Services

Overview

Support Services | Remote | Full Time | Days

• Identifying, analyzing, and researching frequent root causes of denials and develop corrective action plans for resolution of denials.
• Be detailed oriented and formulate appeals, researching and analyzing denial data and coordinating denial recovery responsibilities.
• Apply critical thinking skills to the correct appeal methodology to address denials such as proving medical necessity and retro authorizations appeals.
• Apply proper escalation of outstanding denials including submitting complaints to various agencies such as the Ohio Department of Medicaid and the Department of Insurance.
• Address pre- and post takebacks by health plans; investigate and take appropriate action.
• Prioritize activities to overturn denials in a timely manner to alleviate untimely filings.
• Work with insurance payers to ensure proper billing on all assigned patient accounts.
• Depending on payer contract, participate in conference calls, accounts receivable reports, and compile issue reports to expedite resolution of accounts.
• Follow up daily, maintain established goals, and notify Team Lead and/or Supervisor of issues preventing achievement of goals.
• Follow up on daily correspondence to appropriately work patient accounts.
• Assist Customer Service with patient concerns/questions to ensure prompt and accurate resolution.
• Produce written correspondence to payers and patients regarding status of claims and requesting additional information.
• Initiate next billing, assign appropriate follow-up and/or collection steps; this may include calling patients, insurers, or employers as appropriate.
• Send initial or secondary bills to insurance payers.
• Document billing, follow-up, and/or assign collection steps that are taken and all measures to resolve assigned accounts.
• Escalate to Supervisor/Manager any issues or changes in billing system, insurance carrier, or networks.
• Work other duties as assigned.
• Writing appeals on denials including pre- and post-takebacks.
• Contact payer to acquire status of submitted appeals.
• Join payer calls and participate to address issues.

• High school Diploma or equivalent required.
• Minimum of a year working denials in the healthcare setting;
  Experience in Microsoft tools, Epic EMR Experience (preferred), Relay Health/ePremis Experience (preferred).
• Experience with the Revenue Cycle – registration, medical records, billing, coding, etc.
• Experience with managed care contract terms and federal payer guidelines.
• Experience with medical necessity guidelines and care coordination/case management functions.
• Experience with hospital billing (UB92 form) and coding requirements.
• Understanding of Revenue Cycle Processes.
• In depth understanding of explanation of benefits (EOBs).
• Effective in identifying and analyzing problems; generates alternatives and identifies possible solutions.
• Timely resolution of claim edits allowing timely claim submission.
• Timely follow-up of unpaid claims, worked to ensure maximum reimbursement following compliant standards.
• Ability to work independently as well as collaboratively within a team environment.
• Excellent problem-solving skills.
• Creative ability to escalate of appeals.
• Excellent verbal, written and customer service communication skills.
• Strong analytical ability and critical thinking skills required.
• Takes initiative.
• Creative problem-solving skills.
• Ability to meet deadlines.
• Personable, tactful and cooperative.
• Ability to work well with others.
• Ability to clearly communicate with and establish and maintain good rapport with peers, physicians, hospital administration, nurses and other healthcare team members required.
• Demonstrate integrity, objectivity, and thinking skills required.
• Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, payors, customers and co-workers.