Responsible for denial management and identifying areas of continued process improvements to ensure further decrease in new denials, final write off denials, and pre-bill denials. Works with Team Lead on process improvement opportunities. Coordinates with hospital and professional services billing and follow up teams, Health Information Management, Release of Information and coding; and maintains effective communication with all members of the healthcare team both internal and external.
Responsibilities
- Responsible for denial management and identifying areas of continuous process improvements.
- Resolves payment rejections, denials and validates denial reasons.
- Coordinates internal and external resources to overturn the rejections.
- Initiates and manages appeals as appropriate to obtain maximum reimbursement.
- Works with team leader and team members on process improvement opportunities.
- Evaluates denials to determine and track root cause and implement corrective actions.
- Identifies denial trends and provides information to the denial team to determine ways to prevent future unavoidable denials
- Validates accuracy of Provider and Carrier invoices per policy.
- Manages resolution of exceptions/issues.
- Prepares reports on audit results, process improvement recommendations, and systemic payment errors.
- Assists in the development of financial data collection and tracking tools to analyze data and prioritize denial trends.
Qualifications
Education:
- Associate's Degree Or high school diploma/equivalent with the required experience
Experience:
- Two (2) years of experience (with Associate's degree) or 4 years of experience (with high school diploma/equivalent) in a revenue cycle role including billing and follow-up.
