Our Denials Specialists investigate and analyze accounts in order to properly identify and coordinate insurance benefits and resolve outstanding balances. This is achieved by persuasively arguing through verbal and written appeals that payment should be made to the provider.
PRIMARY DUTIES AND RESPONSIBILITIES MAY INCLUDE ANY OR ALL OF THE FOLLOWING:
- Perform daily tasks as assigned
- Reach daily/monthly goals
- Conduct medical research and develop an understanding of medical conditions using multiple online resources
- Contact patients and insurance carriers by phone, mail, and/or online portals
- Review documentation including but not limited to clinical summaries, provider notes or explanations of benefits in order to obtain knowledge and understanding of account history and patient treatment course
- Use persuasive communication skills to effectively argue on behalf of clients through written and/or verbal appeals
- Use critical thinking skills to resolve aged and problematic accounts
- Conduct initial workups including analyzing account history, obtaining claim status, and determining next steps
- Update patient tracking system with new information and next steps
- Attend team meetings to discuss updates such as new hospital procedures or current client issues
- Communicate issues to manager and/or supervisor, including but not limited to system errors, questions for other departments, or HIPAA questions
- Stay up to date on state laws governing fee schedules, filing limits, and other statutes
- Participate in special projects when presented by management
- Additional duties as assigned
- Comply with company's code of conduct.
- Additional duties and responsibilities as assigned.
- Office environment with some exposure to external environment, temperature changes, uneven walking services.
- Talking: Frequently conveying detailed or important instructions or ideas accurately, clearly, or quickly.
- Hearing: Able to hear average or normal conversations and receive ordinary information.
- Repetitive motion: Frequent and regular use of the wrists, hands, and fingers to make small movements such as typing or picking up small objects. Normal fine and gross motor control of fingers and hands.
- Seeing: Visual acuteness necessary for the proper evaluation of or to prepare, inspect documents or other materials. Ability to accurately view computer monitors.
- Physical: Frequent sitting, standing and walking. Occasional lifting up to 25 lbs, pushing and pulling up to 45 lbs. Occasional kneeling, stooping, and bending at the waist.
POSITION QUALIFICATIONS AND REQUIREMENTS:
- Bachelor's degree is preferred or comparable work experience or combined work experience and education
Knowledge, Skills, Abilities and Competencies:
- Strong typing skills
- Prior experience with resolving denied insurance claims is required
- Demonstrated ability to effectively craft arguments to overturn denials
- Proficient using computer software such as Word, Outlook and Adobe Acrobat
- Ability to learn new software systems
- Consistent ability to work with a high volume of accounts
- Focused and self-motivated
- Excellent investigative, problem-solving, and critical thinking abilities
- Close attention to detail and commitment to accuracy
- Exceptional organization, time management, and prioritization skills
- Ability to adapt to changing environment and implement feedback
- Excellent customer service skills
- Exceptional written and verbal communication skills, including spelling and grammar
- Ability to contribute in a positive manner
- Knowledge of Healthcare Terminology required