Denial Management Specialist-Cert CPFSS (HB)

Job description

Job Summary: Under the direction of the PB Follow Up & Denial Team Supervisor, the PB Follow Up & Denial Team Member is responsible for monitoring claims for Medicare, Medicaid, Government Payors, Commercial Payors and Work Comp Payors through claim follow up and insurance appeals. Essential Job Duties: - Researches and analyzes denial data and coordinates denial recovery responsibilities. - Identifies, analyzes, and researches frequent root causes of denials and recommends corrective action plans for resolution of denials. - Prioritizes activities to work overturns in a timely manner to alleviate untimely filings. - Uses WQ sort/filter options to categorize denials to work to overturn denials. - Researches, responds, and documents insurer correspondence /inquiry notes regarding coding, coverage, benefits, and reimbursement on patient accounts timely and accurately. - Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks. - Helps with coverage for Customer Service when needed. - Receive a passing score on the annual competency evaluation. - Demonstrates knowledge of patient confidentiality and HIPAA regulations. - Organized; sets...