EHPB Denial Management Specialist at EvergreenHealth – Kirkland, Washington

Wage Range: $21.52 - $34.43 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.. Adjustsdenials 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 refer denials, bundling issues and medical necessity for all assigned payers.
6. Logs all denials including actions and resolution on Denial spreadsheet.
7. Identify denial pattern to identify potential process improvement.
8. Produces quarterly denial reports.

License, Certification, Education or Experience:

REQUIREDfor the position:
High School graduate or equivalent.
1-year previous experience in professional billing.
Knowledge and experience in working with health care insurers' and their reimbursement systems, especially Medicare, Medicaid, Workers Compensation, Motor Vehicle and contract payers.
A good understanding of CPT, Modifiers, HCPC, ICD-10 codes and medical terminologies.
Demonstrated problem solving ability.
Ten-key by touch

DESIREDfor the position:
College degree/Vocational training in billing or business

Benefit Information:
Choices that care for you and your family

At EvergreenHealth, we appreciate our employees commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.