Denials Analyst
Description/Job SummaryPOSITION
Summary:
The QA Denial Management Specialist will be responsible for timely and accurate correction to denied claims based on root cause analysis and configuration/maintenance of the denial management module within theEssential Functions Statement(s)Appeal, reprocess, and send reconsiderations on denied claims according to explanation of denial and root cause analysisFollow up on outstanding appeals, reprocesses and reconsiderationsReport insurance policy changes found during root cause analysis to the RCM Quality Assurance Team LeadReport findings of root cause analysis and any recommended solutions to denials based on root cause analysis to the RCM Quality Assurance Team LeadCreate, update, maintain configurations for remittance sets, crossovers, and appeal packages within the billing systemRoot cause insurance related overpayment and refund requests from payersRequest refunds through the billing software when necessary with all proper supporting documentation being available to view by accounts payableDetailed documentation in all accounts that are updated and workedOrganize and store all account letters in appropriate network foldersAssess processes, duties, tasks and recommend updates to improve processes and procedures as neededMaintain basic working knowledge of other Quality Assurance Team Functions (Payer Enrollment and Collections)Other duties as assignedSkills and AbilitiesProven track record of process improvement to drive accuracy and efficiencyEvidenced problem-solverStrong leadership skillsExcellent verbal and written communication skillsDetail-oriented and analytical thinkerDemonstrated ability to project manage (i.
e.
scheduling, critical thinking, communication)Ability to prioritize and maintain composure in stressful timesQualificationsFive years of medical billing experienceProficient with various software applications (Outlook, Excel, Word), computer systems, web-based applications, and third-party portalsKnowledge of commercial and government payersBenefitsCompetitive pay401(k) with immediate eligibility and matchGenerous PTOHealth insurance options for you and your familyMonthly in office chair massages and employer sponsored lunchesCompany-paid Life insuranceCompany-paid LTD CoverageAffordable Vision and Dental plansFlexible Spending Account or Health Savings Account availabilityWellness plan Recommended Skills Accounts Payable Analytical Attention To Detail Billing Business Process Improvement Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
Summary:
The QA Denial Management Specialist will be responsible for timely and accurate correction to denied claims based on root cause analysis and configuration/maintenance of the denial management module within theEssential Functions Statement(s)Appeal, reprocess, and send reconsiderations on denied claims according to explanation of denial and root cause analysisFollow up on outstanding appeals, reprocesses and reconsiderationsReport insurance policy changes found during root cause analysis to the RCM Quality Assurance Team LeadReport findings of root cause analysis and any recommended solutions to denials based on root cause analysis to the RCM Quality Assurance Team LeadCreate, update, maintain configurations for remittance sets, crossovers, and appeal packages within the billing systemRoot cause insurance related overpayment and refund requests from payersRequest refunds through the billing software when necessary with all proper supporting documentation being available to view by accounts payableDetailed documentation in all accounts that are updated and workedOrganize and store all account letters in appropriate network foldersAssess processes, duties, tasks and recommend updates to improve processes and procedures as neededMaintain basic working knowledge of other Quality Assurance Team Functions (Payer Enrollment and Collections)Other duties as assignedSkills and AbilitiesProven track record of process improvement to drive accuracy and efficiencyEvidenced problem-solverStrong leadership skillsExcellent verbal and written communication skillsDetail-oriented and analytical thinkerDemonstrated ability to project manage (i.
e.
scheduling, critical thinking, communication)Ability to prioritize and maintain composure in stressful timesQualificationsFive years of medical billing experienceProficient with various software applications (Outlook, Excel, Word), computer systems, web-based applications, and third-party portalsKnowledge of commercial and government payersBenefitsCompetitive pay401(k) with immediate eligibility and matchGenerous PTOHealth insurance options for you and your familyMonthly in office chair massages and employer sponsored lunchesCompany-paid Life insuranceCompany-paid LTD CoverageAffordable Vision and Dental plansFlexible Spending Account or Health Savings Account availabilityWellness plan Recommended Skills Accounts Payable Analytical Attention To Detail Billing Business Process Improvement Claim Processing Estimated Salary: $20 to $28 per hour based on qualifications.
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