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Job Requirements of Denials Representative:
QUALIFICATIONS / EXPERIENCE: High school diploma or equivalent.
Minimum two years previous medical billing experience required with emphasis on
research and claim denials in Accounts Receivable preferred.
Demonstrated knowledge of physician billing.
Demonstrated knowledge of health care reimbursement guidelines.
Knowledge of ICD-10 and CPT-4 coding.
Excellent oral and written communication.
Knowledge of denials and review policies for all plans.
Thorough working knowledge of physician billing policies and procedures.
Computer literate.
Excellent follow-up skills.
Excellent organizational skills.
Training classes and seminar attendance may require travel.
SUPERVISORY RESPONSIBILITIES:
None
PHYSICAL / ENVIRONMENTAL DEMANDS:
Job performed in a well-lighted, modern office setting
Occasional standing/bending
Occasional lifting/carrying (20lbs or less)
Moderate stress
Prolonged sitting
Prolonged work on a PC/computer
Prolonged telephone work
This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key,
calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions
and/or meet production standards to comply with the essential functions.
Also, may require physical
and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more
than five days per week.
Do you meet the requirements for this job?
Denials Representative
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:
Position is responsible for reviewing rejections assigned to Denials Resolution in ETM System. Maintains accuracy and production to ensure denials are being processed efficiently.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Reviews ETM worklist to process rejections according to written procedures.
Reviews rejections to identify trends and carrier issues that need to be reported to management.
Obtains appropriate carrier information for rejected claims.
Information obtained from carrier indicates related to provider rejection. Directs rejections to the Provider Enrollment Department.
Maintain knowledge of ETM system.
Participates in monthly meeting with Denials Resolution Supervisor.
Communicates with Denials Resolution Supervisor for unusual circumstances that may include adjustments, denials, fee schedules, claims, etc.
Performs any and all duties as directed by Senior Representative, Denials Resolution Supervisor and Accounts Receivable Manager.
Job Requirements:
High school diploma or equivalent.
Minimum two years previous medical billing experience required with emphasis on
research and claim denials in Accounts Receivable preferred.
Demonstrated knowledge of physician billing.
Demonstrated knowledge of health care reimbursement guidelines.
Knowledge of ICD-10 and CPT-4 coding.
Excellent oral and written communication.
Knowledge of denials and review policies for all plans.
Thorough working knowledge of physician billing policies and procedures.
Computer literate.
Excellent follow-up skills.
Excellent organizational skills.
Training classes and seminar attendance may require travel.
SUPERVISORY RESPONSIBILITIES:
None
PHYSICAL / ENVIRONMENTAL DEMANDS:
Job performed in a well-lighted, modern office setting
Occasional standing/bending
Occasional lifting/carrying (20lbs or less)
Moderate stress
Prolonged sitting
Prolonged work on a PC/computer
Prolonged telephone work
This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key,
calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions
and/or meet production standards to comply with the essential functions.
Also, may require physical
and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more
than five days per week.