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:
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.
Tracks and investigates denial trends/ root cause
Assists with claim audits as necessary
Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.
Obtain retro authorizations and submit to payers for reimbursement.
Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.
As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.
Works independently with other departments to resolve A/R and payer issues.
Qualifications
Required:
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
