EHPB Denial Management Specialist

Job description

Wage Range: $21.09 - $33.75 per hour Hybrid in Washington State only - Medical Billing Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity. Job Summary : Investigates health plan denials to determine appropriate action and provide resolution. Primary Duties : 1. investigates insurance denials to identify action necessary. 2. Corrects claims based on denials, complaints and audits and rebills using payor approved process. 3. Determines need for payor appeal and sends individualized appeal letter. Monitors appeals for resolution 4.. Adjusts denials determined to be appropriate using the corresponding adjustment code(s). 5. Works the accounts that meet denial management criteria and coordinates resolution with other departments. Denial management criteria include accounts that have potential financial impact such as authorization and...