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Job Requirements of Denials Representative:
QUALIFICATIONS / EXPERIENCE:▪ Approximately two+ years of experience with insurance denial and correspondence
processes within a multi-facility environment.
▪ High school diploma or equivalent required, some college coursework preferred.
▪ Demonstrated success working in a team environment focused on meeting
organization goals and objectives is necessary.
▪ Knowledge of coordination of benefits requirements and processes.
▪ Knowledge of health insurance correspondence denial processing.
▪ Knowledge of insurance rejection/denial processing to perform follow up activity.
▪ Understanding of physician billing guidelines for commercial and government
payers in multiple states.
▪ Ability to multi-task, set priorities and follow through without direct supervision.
▪ Excellent written and verbal communication and interpersonal skills.
▪ Proven analytical skills and ability to work in a structured, fast-paced environment.
▪ Proficiency in working with billing systems, GE experience is desirable.
▪ Knowledge of Microsoft Excel, Microsoft Outlook, and Microsoft Word.
▪ Must be organized, detail oriented, and meticulous with all tasks.
SUPERVISORY RESPONSIBILITIES:
▪ None
PHYSICAL / ENVIRONMENTAL DEMANDS:
▪ May require the 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 to comply with the essential functions.
▪ Requires the physical and/or mental stamina meet production and quality standards
to comply with the essential functions.
▪ May require physical and/or mental stamina to work overtime, additional hours
beyond a regular schedule and/or more than five days per week with mandatory
overtime as directed by Management.
▪ Requires the ability to conform to standards for attendance.
▪ Job performed in a well-lighted, modern office setting.
▪ Prolonged work on a PC/computer and telephone.
▪ Occasional standing/bending.
▪ Occasional lifting/carrying.
▪ Prolonged sitting.
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:
Under direct supervision, the Denials and Appeals Representative is responsible for processing correspondence, manually or electronically. This position handles follow up on denied claims, appeal status, and processing of denials for all TeamHealth patient accounts. The Denials and Appeals Representative works in a cooperative team environment to provide value to customers (internal or external). The Denials and Appeals Representative carries out his/her duties by adhering to the highest standards of ethical and moral conduct, and acts in the best interest of TeamHealth.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
• Performs diligent follow up, collection and appeals processes to attempt to receive payment on outstanding claims items.
• Proper collections follow-up must be performed.
• Ensures that all denials are researched and followed-up with the maximum collection efforts to ensure payment is received.
• Responsible for completing tasks thoroughly and accurately to ensure the task is not returned back for re-work and there are little or no write offs of tasks.
• Identify trends and issues with workloads and payers and maintains high level of quality.
• Ensures compliance with state and federal laws and regulations for Commercial, Medicare, Medicaid, Managed Care and self-pay payers. • Responsible for all daily, weekly, and monthly reporting requirements.
• Maintains ongoing knowledge of HCFA 1500 and other mandatory state billing forms and filing, HIPAA, and follow up requirements and ensures compliance of CPT, HCPCS and ICD-10 coding regulations and guidelines.
• Responsible for all daily productivity reporting requirements.
• Maintains and exceeds department standards for productivity and quality.
• Functions effectively within a team and participates and contributes constructively to produce results in a cooperative effort.
• Demonstrates ongoing enthusiasm and commitment to the work assigned.
• May perform special assignments and other related tasks as assigned.
Job Requirements:
▪ Approximately two+ years of experience with insurance denial and correspondence
processes within a multi-facility environment.
▪ High school diploma or equivalent required, some college coursework preferred.
▪ Demonstrated success working in a team environment focused on meeting
organization goals and objectives is necessary.
▪ Knowledge of coordination of benefits requirements and processes.
▪ Knowledge of health insurance correspondence denial processing.
▪ Knowledge of insurance rejection/denial processing to perform follow up activity.
▪ Understanding of physician billing guidelines for commercial and government
payers in multiple states.
▪ Ability to multi-task, set priorities and follow through without direct supervision.
▪ Excellent written and verbal communication and interpersonal skills.
▪ Proven analytical skills and ability to work in a structured, fast-paced environment.
▪ Proficiency in working with billing systems, GE experience is desirable.
▪ Knowledge of Microsoft Excel, Microsoft Outlook, and Microsoft Word.
▪ Must be organized, detail oriented, and meticulous with all tasks.
SUPERVISORY RESPONSIBILITIES:
▪ None
PHYSICAL / ENVIRONMENTAL DEMANDS:
▪ May require the 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 to comply with the essential functions.
▪ Requires the physical and/or mental stamina meet production and quality standards
to comply with the essential functions.
▪ May require physical and/or mental stamina to work overtime, additional hours
beyond a regular schedule and/or more than five days per week with mandatory
overtime as directed by Management.
▪ Requires the ability to conform to standards for attendance.
▪ Job performed in a well-lighted, modern office setting.
▪ Prolonged work on a PC/computer and telephone.
▪ Occasional standing/bending.
▪ Occasional lifting/carrying.
▪ Prolonged sitting.