Sr. Denials Representative - Remote

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Job description

JOB DESCRIPTION OVERVIEW:

The Sr. Denials Representative specialist is responsible for maintaining accuracy and production for the department, overseeing daily functions of employees and training of department staff. The senior provides leadership and guidance to the Representatives. The department's goal is to examine and take action to support the provider's interests in working significant denials and appeals from insurance carriers.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Reviews ETM PIT reports daily to provide guidance to employees on effectively organizing and working assignments.
• Provides training to new staff, as well as, in service training of established staff.
• Reviews various denials to determine appropriate action based on carrier requirements.
• Reports any consistent errors found that affects claims from being processed correctly.
• Participates in departmental meetings.
• Provides assistance to the Denials Resolution, Charge Correction, and Authorization representatives on the ETM system and with their tasklist.
• Reviews claims that have been denied and require intervention. This includes assembling documentation, documenting IDX and maintaining documentation on claims for possible legal intervention.
• Communicates with Supervisor and/or AR Manager to keep them informed of any detected problems or changes in AR.
• Performs quality audits on Denials Resolution, Charge Correction, and Authorization staff members.
• Assists with research and development of appropriate denial procedures.
• Creates and updates policy and procedures for department.
• Other duties as assigned by the AR Manager.

EXPERIENCE / SKILLS:

• Minimum two years previous medical billing experience required with emphasis on research and claim denials in Accounts Receivable.
• Demonstrated knowledge of physician billing.
• Demonstrated knowledge of health care reimbursement guidelines especially Medicare and Medicaid.
• Knowledge of ICD-9, ICD-10 and CPT-4 coding.
• Good oral and written communication.
• Knowledge of appeals and reviewing policies for state and government plans.
• Thorough working knowledge of physician billing policies and procedures.
• Computer literate.
• Excellent follow-up skills.
• Excellent organizational skills.
• Knowledge of Microsoft Office applications such as Excel and Word.

EDUCATION:

• High school diploma or equivalent.

WORKING CONDITIONS:

• Set in a pleasant, high-volume, fast-paced office environment. Involves extensive computer use.
• Overtime may be required and can be mandated by Management.

TRAVEL:

• Training classes and seminar attendance may require travel.

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