Denials Representative

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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

Overview

The Denials Representative will review, organize, and monitor incoming payment denials, taking appropriate corrective action. The Analyst responds to carrier issues as needed and processes all appeals including Medicare, Medicaid, Blue Shield, and Commercial carriers.

Essentials Duties and Responsibilities

• Monitor and review all payment denials as assigned in Enterprise Task Manager and process these claims in the time frame assigned within the system
• Utilize the telephone and various carrier websites as research tools to expedite resolution for issues
• Assembles and forwards documentation to appeal disputed claims through Waystar, if applicable
• Assist with research and development of appropriate denial procedures
• Contacts carriers to inquire on claims that have been denied and appealed
• Assembles and forwards appropriate documentation to the Senior Analyst for provider-related issues
• Review carrier manuals and websites and informs management of any new procedures implemented by the carrier that are impacting our claims
• Reports any consistent errors found during claims review that may affect claims from being processed correctly
• Consistently meets established completion times for projects and assignment
• Consistently meets and maintain the QA (95% or better) and designated production standards per sub-teams

Qualifications / Experience

• 1 – 3 years of experience in physician medical billing with an emphasis on research and claim denials
• Thorough knowledge of physician billing policies, procedures and healthcare reimbursement guidelines
• Computer literate, working knowledge of MS Excel
• Ability to consistently meet production, quality and attendance metrics
• Good organizational and analytical skill
• Ability to work independently
• High school diploma or equivalent
• General knowledge of ICD and CPT coding