Denials and Eligibility Specialist

Denials and Eligibility Specialist

Position Summary

Revenue Cycle Denials and Eligibility Specialist will be responsible for daily QA, eligibility, frontend rejections, denial auditing, and immediate correction of all registered accounts to ensure accurate billing and reimbursement. The scope of work will encompass all Government, Commercial, and Managed Care payers, and include all service lines and all denial types. Position will be a liaison with other departments, physicians and other clinicians within and outside the organization in order to facilitate timely and accurate submission. This position will work closely with management, precertification, insurance verification, and operations to ensure trends are identified and corrected to reduce denials. Revenue Cycle Denials and Eligibility Specialist will also be involved with education and training based on identified trends and audit results.

Education

None Required

Experience

2-3 years hospital revenue cycle experience

1-2 Years insurance experience

Previous Team Lead or Supervisor Experience - Preferred

License & Certification

None Required

Core Job Functions

Directly works to resolve all eligibility denials in billing system and from payer remits within 1 business day. Directly resolves all RQA errors within 1 business day.

Completes monthly Root Cause Analysis on denials and eligibility to determine trends and using the results to keep leadership informed and provide continuing education and improvement.

Reviews monthly denials with leadership teams of the physician's office, ancillary departments and revenue cycle. Identifies improvement opportunities, educational needs and reduction of denials opportunities.

Escalates eligibility and payer denial trends or underpayments to appropriate internal leadership for quick resolution.

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