Denials Specialist - Nashville, United States - Insight Global

Description

Job Purpose:

The Denials Specialist generates revenue by monitoring and pursuing payment on all unpaid and delinquent denied claims; serving as a liaison between the Provider, Payors, and Patient with regards to payment collections; and maintaining daily and monthly productivity goals to maximize cash flow.

Essential Functions:
Work all Verification or Benefit and Authorization denied claims received by payers.

Responsible for verifying patient benefit eligibility including private, government and third party insurance information to ensure coverage of dates of service being worked.

Coordination with authorization team when and if an authorization is needed
Able to research denied CPT codes with comparison to the LCD/NCD requirements
Effectively identifies trends that inhibit timely claim submission and payment
Work average of 30-50 denials per day based on supervisor requirements and accounts assigned
Works closely with insurance carriers for reimbursement requirements to ensure payment
Provides clear and accurate documentation of all contacts or action completed with any internal or external persons concerning patient accounts
Quickly becomes familiar with duties and performs them independently, accurately, efficiently, promptly, recognizing their importance and relationship to patient care
Initiate and complete appeals for disputed / denied claims.
Works / Understands electronic claim interchange
Understands life cycle of primary and secondary claims
Maintains a positive front office support relationship
Takes incoming calls from insurance carriers and patients
Regular attendance and punctuality.
Contributes to team effort by accomplishing related results as needed.
Ensures that all processing and reporting deadlines are consistently achieved.
Perform any other functions as required by management.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day.

We are an equal opportunity/affirmative action employer that believes everyone matters.

Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances.

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Required Skills & Experience

• Minimum 2 years experience in Insurance followup, or medical biller/coding background
• Experience with computerized billing software and interpreting EOBs
• Working knowledge of ICD9/ICD10, CPT, HCPCS, and CPT coding

Nice to Have Skills & Experience

• Oncology experience

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching.

Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.