SENIOR DENIALS RECOVERY SPECIALIST Business & Information Technology Hours: M-F 8-4:30 flexible Day Shift - Full Time Paygrade/Wages/Salary Info: NE N25 - 22.7500 - 28.5500
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. # T The Ideal Candidate: In depth knowledge of Medicare and Medicaid regulations, third party reimbursement guidelines. Computer literate, knowledge of financial data analysis, intermediate Excel skills. Preferred # Physician claims experience in a multi-specialty environment, preferably with oncology and/or surgical experience. # Responsibilities: # 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 as assigned. # Credentials and Qualifications: ####Bachelor#s degree in Healthcare, Finance, or another related field required. ##### A 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; # #### * -OR- Associate 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/GED 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.##