Denials Management Specialist

POSITION SUMMARY :

The denials management specialist role involves analyzing, resolving, and preventing denied insurance claims within the Epic electronic health record system. This role requires expertise in healthcare billing, coding, and insurance policies to identify root causes of denials, appeal incorrect decisions, and implement strategies to minimize future denials. This position is a hybrid position.

EDUCATION & EXPERIENCE :

Associates degree, 3+ years of experience with Epic's billing modules and reporting tools, advanced training in Medical Billing or Coding, including CPC certification required or an equivalent combination of education, experience, training and certification will be considered. Advanced training in Medical Billing or Coding, including CPC certification is preferred.

Knowledge of Medical Terminology required. Demonstrated understanding of billing requirements for claims, demonstrated knowledge of healthcare insurer reimbursement systems, payer contract, appeal rights, and demonstrated knowledge of timely filing requirements of payers. Excellent customer service skills and the ability to communicate effectively with all staff and patients. Ability to independently research and retrieve information from internal reference material or from outside sources. Demonstrated critical thinking skills, computer skills; data entry skills, Math Skills (+, -, x, / ); and EXCEL experience. Knowledge of procedural / diagnostic coding, ADA / CPT-4, HCPCS and ICD-10-CM, preferred. Communicate effectively in both written and oral format about clinical information, work independently, exercise judgement and problem solving in investigating denied claims, build a positive rapport with colleagues and work with all levels of the organization and third party payers to resolve issues as needed. Ability to analyze data, identify trends, and determine root causes of denials.

PHYSICAL REQUIREMENTS :

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle objects; controls, reach with hands and arms; climb stairs; balance; stoop; kneel; talk or hear; taste or smell. The employee must occasionally lift up to 15 pounds. Specific vision abilities required by the job include close vision, distance and color vision, peripheral vision, depth perception and the ability to adjust focus.