Denials Management Specialist- Revenue Integrity- Days

Responsible for denial management and identifying areas of continued process improvements to ensure further decrease in new denials, final write off denials, and pre-bill denials. Works with Team Lead on process improvement opportunities. Coordinates with hospital and professional services billing and follow up teams, Health Information Management, Release of Information and coding; and maintains effective communication with all members of the healthcare team both internal and external.

• Responsible for denial management and identifying areas of continuous process improvements.
  
  
  
  • Resolves payment rejections, denials and validates denial reasons.
  
  
  • Coordinates internal and external resources to overturn the rejections.
  
  
  • Initiates and manages appeals as appropriate to obtain maximum reimbursement.
  
  
  • Works with team leader and team members on process improvement opportunities.
  
  


• Evaluates denials to determine and track root cause and implement corrective actions.
  
  
  
  • Identifies denial trends and provides information to the denial team to determine ways to prevent future unavoidable denials
  
  
  • Validates accuracy of Provider and Carrier invoices per policy.
  
  
  • Manages resolution of exceptions/issues.
  
  
  • Prepares reports on audit results, process improvement recommendations, and systemic payment errors.
  
  
  • Assists in the development of financial data collection and tracking tools to analyze data and prioritize denial trends.
  
  

Education:

• Associate's Degree Or high school diploma/equivalent with the required experience

Experience:

• Two (2) years of experience (with Associate's degree) or 4 years of experience (with high school diploma/equivalent) in a revenue cycle role including billing and follow-up.