Healthcare Claim Denial Specialist 72466
Our client, a Houston area law firm, seeks a Denial Specialist to join their firm. The Denial Specialist analyzes health care insurance/litigation patient account files and contacting insurance companies and patients to resolve all outstanding and delinquent insurance payments due to the client and works to recover payments for healthcare providers when insurance companies deny, underpay, or refuse to pay medical claims.
Requirements:
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Perform basic duties as assigned in a professional manner, which include interacting with clients, insurance payors, attorneys and team members as needed.
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Responds promptly to emails and telephone messages.
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Participates in meetings, training sessions, seminars and in-services in a positive and professional manner.
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Basic computer skills to navigate through various systems and applications provides for working accounts to resolution. (Must have basic Excel skills.)
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Good oral and written skills are required.
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Knowledge in working all payor websites: Availity, UHC: Medicare and all others to find status on accounts, upload Medical Records, file Reconsideration, Appeal, pull EOB’s, UB04s and all correspondence needed to work an account.
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Document clear and concise notes in our system regarding claim status, denial reason and next steps.
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Maintain individual productivity goals of an average of 45 accounts per day.
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Communicate all issues including system, compliance, payor, behavior, workflow or any other insurance collection opportunities to manage immediately.
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Provide support for team members that me be out or backlogged willingly.
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Work projects or other duties as assigned.
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Must have above average analytical and critical thinking skills.
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Must be able to make sound decisions.
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Must have the ability to problem solve, prioritize duties and follow through completely with assigned tasks.
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Must have a good understanding of the Commercial, Managed Care, Medicare collection processes and a basic knowledge of Managed Care contracts, Contract Language and Federal and State Requirements for government payors.
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College degree preferred but not required.
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Required, high school diploma.
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Three or more years related experience in health care insurance collections is required.
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Bilingual in Spanish and English is a plus but not required.
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Ability to read and comprehend simple instructions, short correspondence, and memos.
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Ability to draft simple correspondence.
Duties:
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Work your Collector Desk Report for daily account assignment based on day of the week schedule.
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Review the Denial listed on the account and determine if it is correct by reviewing all necessary documentation in all systems available (TCS, Availity and Client System) and determine if the assigned denial is correct and identify next steps.
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Document findings and next steps.
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Preform next steps required to move the account forward in the collection process.
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Complete all required fields needed for projects and mediation reviews.
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Is required to submit reconsiderations to a payor with all appropriate supporting documentation.
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Is required to analyze clinical data provided by the client to write a clinical appeal letter.
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Identifies repetitive denial reasons and submits information to leadership for a potential grouper. Collector will still attempt to collect these accounts while waiting on further directions from the Attorney.
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Is required to keep up with changes and updates to State, Federal and Payor guidelines share with the Team.
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Other projects and duties as assigned.