SENIOR DENIALS RECOVERY SPECIALIST Position Available In Hillsborough, Florida

SENIOR DENIALS RECOVERY SPECIALIST

Location Tampa, FL
Facility Remote
Department MMG PFS Admin
Req #: 84993 At Moffitt Cancer Center, we strive to be the leader in understanding the complexity of cancer and applying these insights to contribute to the prevention and cure of cancer. Our diverse team of over 9,000 are dedicated to serving our patients and creating a workspace where every individual is recognized and appreciated. For this reason, Moffitt has been recognized on the 2023 Forbes list of America’s Best Large Employers and America’s Best Employers for Women, Computerworld magazine’s list of 100 Best Places to Work in Information Technology, DiversityInc Top Hospitals & Health Systems and continually named one of the Tampa Bay Time’s Top Workplace. Additionally, Moffitt is proud to have earned the prestigious Magnet® designation in recognition of its nursing excellence. Moffitt is a National Cancer Institute-designated Comprehensive Cancer Center based in Florida, and the leading cancer hospital in both Florida and the Southeast. We are a top 10 nationally ranked cancer center by Newsweek and have been nationally ranked by U.S. News & World Report since 1999.
Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. Join our committed team and help shape the future we envision.

Summary Senior Denials Recovery Specialist Position Highlights:

Responsible for the coordination and management of timely insurance claim follow-up including identifying, monitoring, appealing, and resolving denied claims. Perform detailed analysis on denied claims with a focus on maximizing revenue.

ESSENTIAL FUNCTIONS

Submit appeals electronically and/or mail. Follow up electronically and/or telephonically with payers for claim and appeal status.
Make a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted.
Research and prepare responses for payer requests for additional information and documentation.
Review of non-clinical denials including identification of root cause.
Resolve non-clinical denials which include researching and reviewing payer guidelines, writing and submitting appeals with supporting documentation if required.
Identifies coding, billing, or reimbursement errors/discrepancies with the denial or aging claim in order to escalate to the denial recovery supervisor.
Other duties including special projects as assigned.

Education and Experience:

Bachelor’s Degree in Healthcare, Finance, or other related field
Minimum of six (6) years experience working with medical claims in a hospital, physician, payor or third party medical billing service setting with collection experience is required.

• -OR- Associate’s degree with an additional two (2) years of relevant claims/collection experience plus the six (6) years (for a total of 8 years) experience may be considered “in lieu” of a Bachelor’s degree.
• -OR- High School Diploma with an additional four (4) years of relevant claims/collection experience plus the six (6) years (for a total of 10 years) experience may be considered “in lieu” of a Bachelor’s degree. In depth knowledge of Medicare and Medicaid regulations, third party reimbursement guidelines. Successful experience in tracking claims, drafting appeals, overturning denied claims.
• For HMO/PPO/Commercial Collectors, experience with non-government payors preferred, including eligibility inquiries, billing and claim submission experience.
• For Government Collectors, experience with Medicare and/or Government payors preferred, including eligibility inquiries, billing and claim submission experience.
• For Medicaid/Medicaid HMO Collectors, experience with Medicaid/Medicaid HMO payors preferred, including eligibility inquiries, billing and claim submission experience.

Preferred:

Master’s Degree in Healthcare, Finance, or other related field.