Senior Denials Recovery Specialist

Position Highlights:

Responsible for the coordination and management of timely insurance claim follow-up including identifying, monitoring, appealing, and resolving denied claims. Perform detailed analysis on denied claims with a focus on maximizing revenue.

ESSENTIAL FUNCTIONS:

• Submit appeals electronically and/or mail. Follow up electronically and/or telephonically with payers for claim and appeal status.
• Make a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted.
• Research and prepare responses for payer requests for additional information and documentation.
• Review of non-clinical denials including identification of root cause.
• Resolve non-clinical denials which include researching and reviewing payer guidelines, writing and submitting appeals with supporting documentation if required.
• Identifies coding, billing, or reimbursement errors/discrepancies with the denial or aging claim in order to escalate to the denial recovery supervisor.
• Other duties including special projects as assigned.

Education and Experience:

• Bachelor's Degree in Healthcare, Finance, or other related field
• Minimum of six (6) years experience working with medical claims in a hospital, physician, payor or third party medical billing service setting with collection experience is required.

* -OR- Associate’s degree with an additional two (2) years of relevant claims/collection experience plus the six (6) years (for a total of 8 years) experience may be considered "in lieu" of a Bachelor’s degree.

* -OR- High School Diploma with an additional four (4) years of relevant claims/collection experience plus the six (6) years (for a total of 10 years) experience may be considered "in lieu" of a Bachelor’s degree.

In depth knowledge of Medicare and Medicaid regulations, third party reimbursement guidelines.

Successful experience in tracking claims, drafting appeals, overturning denied claims.

• For HMO/PPO/Commercial Collectors, experience with non-government payors preferred, including eligibility inquiries, billing and claim submission experience.

• For Government Collectors, experience with Medicare and/or Government payors preferred, including eligibility inquiries, billing and claim submission experience.

• For Medicaid/Medicaid HMO Collectors, experience with Medicaid/Medicaid HMO payors preferred, including eligibility inquiries, billing and claim submission experience.

Preferred:

• Master’s Degree in Healthcare, Finance, or other related field.