Denials Management Specialist

Denials Management Specialist 🔍 Michigan, Shelby Township New 📁 Administrative/Clerical 💼 McLaren Health Care Corp 📅    26002763 Requisition # Apply for Job Share this Job Sign Up for

Job Alerts Position Summary:

The Denials Management Specialist is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The specialist will work independently while managing their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered. Essential Functions and Responsibilities as

Assigned :

1. Monitors denial work queues and reports in accordance with assignments from direct supervisor. Maintains required levels of productivity while managing tasks in work queues to ensure timeliness of follow-up and appeals. 2. Tracks and investigates denial trends/ root cause. 3. Assists with claim audits as necessary. 4. Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network. 5. Obtain retro authorizations and submit to payers for reimbursement. 6. Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions. 7. As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management. 8. Works independently with other departments to resolve A/R and payer issues. 9. Participates in departmental and team meetings involving discussion of A/R processes and trends. 10. Knowledge of payer edits, rejections, rules, and how to appropriately respond to each to resolution.

Qualifications:

Required:

High School Diploma or GED 7 years experience in Patient Accounting or Patient Access experience OR Associates Degree with 3 years of Patient Accounting or Patient Access experience

Additional Information Schedule:

Full-time Requisition ID:

26002763

Daily Work Times:

8am - 4:30pm

Hours Per Pay Period:

80

On Call:

No Weekends:

No