Denial Management Specialist - Physician Enterprise Revenue Cycle
SUMMARY: The Denial Management Specialist is responsible for monitoring denials, appeals, and resolutions from participating insurance carriers and working proactively to collect under payments from insurance carriers. Maintains denial management processes, including but not limited to creation of reconsideration letters. Researches and analyzes denial data to include root cause of denial. This position will also serve as a liaison between the PERC and Physician Practices to provide feedback regarding findings and education to prevent future denials.
BAXTER HEALTH COMPLIANCE RESPONSIBILITIES
Understands and adheres to Baxter Health standards and policies.
Required to work with the Director regularly to carryout, initiate and/or implement best practices for the Baxter Health Physician Enterprise Revenue Cycle Department.
JOB REQUIREMENTS
Education: High school diploma or equivalent required
Experience: Minimum of two (2) years’ experience with Medical Billing required; Minimum of two (2) years’ experience within the medical industry is preferred; Experience working with both government and commercial payers required.
Other: Clear understanding of claims processing and appeal process; Working knowledge and clear understanding of payer denials; Strong problem-solving skills that exhibit resourcefulness; Collaborates well with others by sharing skills and knowledge; Knowledge of CPT, ICD10 coding; Navigation of multiple computer screens and browsers quickly and accurately; Excel in a very fast-paced team environment; Strong communication skills & professional demeanor.
Preferred Education: Associates Degree
Safety Sensitive Designation:
No
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without an accommodation. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to perform the following: Must have the ability to communicate effectively, orally and in writing, to solve problems and make decisions. Spend eight hours or more in front of computer, monitor or similar screen utilizing keyboard and/or mouse, daily. Ability to stand and walk, bend, squat and twist, and occasionally lift up to 20 pounds with proper body mechanics. Must be able to handle critical and highly stressful situations with efficiency and composure.
Work Environment
Office setting, within an office environment
Listed under Healthcare & Nursing jobs.