Sr. Denials Representative

TeamHealth is proud to be the leading physician practice in the U.S. providing exceptional patient care, together. Newsweek Magazine recognizes TeamHealth ‘as one of the greatest workplaces for diversity and one of the greatest workplaces for women; 2024-2025’. Becker’s Hospital Review names TeamHealth among the top 150 places to work in healthcare. We continue to grow across the country from our Clinicians to Corporate Employees. Join us!

What we Offer:

• Career Growth Opportunities
• A Culture anchored in a strong sense of belonging
• Benefits (Medical/Dental/Vision) begin the first of the month following 30 days of employment
• 401k (Discretionary match)
• Generous PTO
• 8 Paid Holidays
• Equipment Provided for Remote Roles

JOB DESCRIPTION OVERVIEW:
The Sr. Denials Resolution Representative is responsible for maintaining accuracy and production for the department, overseeing daily functions of employees and training of department staff. The senior provides leadership and guidance to the Representatives. The department’s goal is to examine and take action to support the provider’s interests in working significant denials and appeals from insurance carriers.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Reviews enterprise task manager (ETM) reports daily to provide guidance to employees on effectively organizing and working assignments
• Provides training to new staff, as well as, in service training of established staff
• Reviews various denials to determine appropriate action based on carrier requirements
• Reports any consistent errors found that affects claims from being processed correctly
• Participates in departmental meetings
• Provides assistance to the Denials Resolution, Charge Correction, and Authorization representatives on the ETM system and with their task list
• Reviews claims that have been denied and require intervention. This includes assembling documentation, documenting IDX and maintaining documentation on claims for possible legal intervention
• Communicates with Supervisor and/or AR Manager to keep them informed of any detected problems or changes in AR
• Performs quality audits on Denials Resolution, Charge Correction, and Authorization staff members
• Assists with research and development of appropriate denial procedures
• Creates and updates policy and procedures for department
• Performs other duties and assignments as requested

EXPERIENCE / SKILLS:

• High school diploma or equivalent
• 2+ years of previous medical billing experience required with emphasis on research and claim denials in Accounts Receivable
• Demonstrated knowledge of physician billing
• Demonstrated knowledge of health care reimbursement guidelines especially Medicare and Medicaid
• Knowledge of ICD-9, ICD-10 and CPT-4 coding
• Good oral and written communication
• Knowledge of appeals and reviewing policies for state and government plans
• Thorough working knowledge of physician billing policies and procedures
• Excellent follow-up skills and organizational skills.