Denial Management Associate

Job Description

About this role:

Our company is seeking a full time Denial Management Associate to review denied claim responses received from insurance carriers and take appropriate action to recover revenue for provided products from payers, patients, or alternate funding sources.

Responsibilities:

• Identify and analyze root causes of denials and develop corrective action plans for denial resolutions
• Submit corrected/replacement claims and process appeals to recover revenue on unpaid claims
• Communicate with patients, practitioners, payers, and/or referral sources to acquire any additional documentation and information required to proceed with revenue recovery
• Accurately review a target number of accounts on a daily, weekly, and monthly basis as determined by assigned work queues, with the ability to prioritize work lists to assist with the urgent investigation of denied claims
• Research, respond, and document insurer and patient correspondence communication regarding coding coverage, benefits, and reimbursement on patient accounts
• Resolve any outstanding disputes
• Provide daily status updates on work performed, overall work queue status, denial trends, and encountered challenges
• Collect amounts owed to cover cost of products for which reimbursements from a payer source is not possible or not applicable.
• Research Explanation of Benefits rejection reasons for proper denial management organization

Qualifications:

• Knowledge of claim response reason codes and remark codes
• Understanding of the health insurance process across multiple payer sources
• Understanding of a CMS-1500 claim form and major claim components such as HCPCS codes, modifiers, ICD-10 diagnosis codes, claim narratives, and claim resubmission codes
• Knowledge working with electronic health records (EHR/EMR) or healthcare related computer systems
• Results-Oriented and Decision-making skills
• Understanding of billing procedures and navigating through resource tools
• Excellent written and verbal communication skills and interpersonal skills are required
• Previous medical billing experience in the healthcare industry preferred