Denials Specialist - Rancho Mirage, United States - VBeyond Healthcare

VBeyond Healthcare
VBeyond Healthcare
Verified Company
Rancho Mirage, United States

3 weeks ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description

Responsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends and providing monthly reports.

Responds to audit requests (including RAC) from payors. Maintains a Library of Payer reference material regarding requirement for pre-authorization, medical necessity and documentation requirements. Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for future denials.


Essential Responsibilities

  • Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations
  • Analyze denied, underpaid and unpaid claims.
  • Appeal underpaid and denied claims within timely filing periods
  • Identify, track and report on denial trends
  • Maintain an appeals data base to identify and report outcomes and opportunities
  • Identify any billing and/or coding trends resulting in denials and report to the Coding manager
  • Identify any other trends resulting in denials and report to Manager.
  • Attend all available coding and appeals related seminars as available

Specific Skills, Knowledge, Abilities Required

  • Strong Analytical skills, Proficient in Microsoft Windows with emphasis on Excel.
  • Ability to prioritize and coordinate workflow and attention to detail. Knowledge of CPT, HCPC and ICD 10 coding requirements with emphasis on modifiers and diagnosis association.
  • Working knowledge of LCD's, NCCI and MUE edits as well as a general knowledge of Commercial, HMO, and Medicare Advantage claims, authorization and documentation requirements.

Experience

  • Required: Minimum of two years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing Prior hospital billing experience a plus.
-
Preferred: three to five years of Patient Accounting in a high volume environment


Education and Certification-

  • Required: High School diploma or equivalent
  • Preferred: Associate degree
  • Preferred: Certified coder or currently enrolled in a coding program

Job Types:
Contract, Temporary


Pay:
Up to $900.00 per week


Schedule:

  • 8 hour shift
  • Day shift
  • Evening shift
  • Monday to Friday
  • Night shift
  • Weekends as needed

Work setting:

  • Hospital

Education:


  • Associate (preferred)

Experience:


  • ICD10: 1 year (preferred)
  • Professional billing: 2 years (required)
  • Hospital
billing: 1 year (required)

  • Patient Accounting in a high volume environment: 3 years (required)
- in Managed Care denial follow up: 1 year (preferred)


License/Certification:

  • Certified Professional Coder (preferred)

Ability to Commute:

  • Rancho Mirage, CA (required)

Ability to Relocate:

  • Rancho Mirage, CA: Relocate before starting work (required)

Work Location:
In person
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