Job Summary:

The Denials Specialist provides administrative support in the revenue cycle of client's businesses by reviewing and submitting accurate claims and managing denied insurance claims. This role involves reviewing, analyzing, and resolving claim submissions and claim denials, as well as collaborating with insurance companies, healthcare providers, and patients to ensure timely reimbursement. The Denials Specialist demonstrates excellent organizational skills and the ability to perform well in stressful situations and work independently. This position requires knowledge of healthcare system operations, medical denials, and use of office equipment and software.

Key Responsibilities:

Reviews provider submitted charges and ensures there are no obvious issues that would lead to claim denial.
Submits charges to insurance companies via established billing systems.
Monitors and tracks denied claims to ensure timely follow-up.
Analyzes denial reasons and categorizes them for efficient follow-up.
Corrects and resubmits denied claims when appropriate.
Contact insurance companies to appeal denials and resolve claim issues.
Serves as a liaison between our healthcare provider clients, patients and insurance carriers.
Responds to inquiries from patients and staff regarding claim statuses.
Maintains accurate and up to date records of denials, appeals, and claim adjustments.
Generates reports on denial trends and recovery performance for clients and management.
Recommends process improvements based on analysis of denial patterns.
Posts payments to accounts from both insurance providers and patients.
Sends patient statements to patient via established processes.
Ensures compliance with healthcare regulations, payer policies, and company standards.
Stays updated on changes in insurance guidelines and billing practices.
Follow up on submitted appeals with payers and document and track appeal status.
Maintains accurate and up-to-date records in compliance with privacy regulations (e.g. HIPAA).
Assists in creating written business processes and procedures to ensure continuity.
Scan in and save documents to appropriate folder/location.
Assists in keeping data and documents stored in an organized manner.
Professionally responds to all customers, insurance providers, patients, and employee grievances, complaints, and/or inquiries and seeks assistance when necessary.
Assists and performs duties within the scope of practice to support business operations.
Assists in answering office phone calls, faxes and emails and appropriately responds to needs in a timely manner.
Ensure compliance with health care regulations and organizations policies and procedures.
Assist in onboarding new employees.
Assists in provider credentialing.

Qualifications:

High school diploma or equivalent (Associate degree preferred). Previous experience in hospital medical billing or claims processing is required. Familiarity with insurance processes, CPT/ICD coding, and medical terminology. Proficiency in office software (e.g., Microsoft Office Suite), electronic medical records (EMR) systems, billing systems, etc.

Key Competencies:

Strong organizational skills.
Attention to detail.
Ability to work independently and efficiently. Ability to prioritize and complete multiple tasks on a daily basis. Excellent verbal and written communication skills.
Ability to handle highly confidential information.
Ability to perform well in stressful situations.
Customer service oriented and the ability to solve complex problems and/or disagreements within the office and with customers.
Strong interpersonal skills to work collaboratively with the Apricity and client teams and diverse groups.
Show an eagerness and capacity to learn and adapt to change.

Position Details:

Full-time, Monday-Friday.
Off on Apricity recognized holidays
Hourly position
Gibson City, IL office, hybrid position allowed if qualifications met
Competitive benefit package

Pay:

$20.00 - $24.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Paid time off Vision insurance Application Question(s): You are aware this is a non-remote position located in Gibson City, IL?

Work Location:

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