Location: Fairfield, NJ
The Denial Management Specialist is responsible for providing various support within the Medical Billing Department related to all payors. This position involves collecting and managing accounts, following up with insurance companies, reconciling accounts, filing corrected claims, appealing claims when appropriate, and following up on all denials to ensure reprocessing and payment in a timely manner. In addition, the individual must follow all policies and procedures as outlined by the company and government regulations per HIPAA regulations.
Job Duties and Responsibilities:
Core duties and responsibilities include the following. Other duties may be assigned
- Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement
- Receives denied claims and researches appropriate appeal steps
- Communicates directly with the payor, resubmits denied claims, underpaid claims and claims that are inaccurately processed by auditing accounts to check on proper payments, coding, balances, adjustments, etc. and also using appropriate reports and working queues
- Tracks and documents all denials by payor, visit type and denial category
- Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials
- Under the direction of leadership works with necessary departments in order to drive process improvement and system edits
- Works with the payors to understand specific reasons for denials and preventable measures available to prohibit future denials
- Reviews monthly system report for the Management Leadership Team
- Prepares an analytical summary report identifying areas of concern by dollar amount, volume and new denials
- Tracks improvement of targeted denials once process or system edits have developed to reduce/prevent future denials
Education and Experience:
- High school diploma
- 1-3 years relevant work experience in medical billing and revenue cycle required
- Experienced with medical insurance, the claim submission process, and rebilling denied claims required
- Knowledge of CPT, ICD-9 and ICD-10 coding
- Understanding of medical and insurance terminology
- Knowledge with Compliance, Law & Ethics (HIPAA)
- Bilingual in English & Spanish a plus
- Knowledge of Podiatry a plus
Required Abilities and Skills:
- Excellent verbal and written communications skills
- Problem-solving and critical-thinking skills
- Proficiency in Microsoft Office Applications including Excel, PowerPoint, and Word
Podiatrists have enough on their plates without having to worry about the minute details of their daily office operations. From insurance concerns to billing issues a large chunk of the medical office workday is spent on administrative red tape.
Statistics show that the majority of podiatrist’s revenues are directly attributed to health insurance reimbursements—yet it’s these very same companies who routinely drag their feet when it comes to issuing claim payments. In today’s temperamental economy, securing a trustworthy podiatry billing service has never been more crucial.
Role: Medical Billing - Denial Management - Fairfield, NJ
Location: Parsippany-Troy Hills Township,
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