CPC-Certified Denials & Claims Resolution Specialist

Brown University Health; Providence (RI); On-site; USD 28,000 - 45,000; Full time

Job summary

Brown University Health in Providence, RI, is seeking a claims follow-up specialist to review denied claims and correct them for adjudication. The role requires 1–3 years of billing experience and knowledge of ICD, CPT, HCPCS, and 1500 forms, with Epic experience a plus.

Under supervision, you will work with payer updates, maintain HIPAA compliance, and collaborate with internal teams to resolve issues and improve revenue cycle processes.

Qualifications

• High school diploma or equivalent.
• Knowledge of 3rd party billing: ICD, CPT, HCPCS and 1500 claim forms.
• Strong communication and problem-solving skills.
• 1–3 years of professional billing experience.
• Epic experience a plus.

Responsibilities

• Review all denied claims, correct them in the system and send corrected/appealed claims as written correspondence, fax or via electronic submission.
• Identify and analyze denials and enact corrective measures as needed to effectively communicate and resolve payer errors.
• Continually maintain knowledge of payer updates via payer’s listservs, provider updates, webinars, meetings and websites.
• Understand and maintain compliance with HIPAA guidelines when handling patient information.
• Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials.
• Report to supervisor identification of denial trends resulting in revenue delays.
• Answers telephone inquiries from 3rd party payers; refer all unusual requests to supervisor.
• Retrieve appropriate medical records documentation based on third party requests.
• Refer all accounts to supervisor for additional review if the account cannot be resolved according to normal procedures.
• Work with management to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department.
• Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures, and objectives of the system and affiliates.
• Perform other related duties as required.

Skills

Critical thinking

Diplomacy

Relationship-building

Communication skills

Problem solving

Education

High school diploma

Tools

Epic

Job description

Brown University Health in Providence, RI, is seeking a claims follow-up specialist to review denied claims and correct them for adjudication. The role requires 1–3 years of billing experience and knowledge of ICD, CPT, HCPCS, and 1500 forms, with Epic experience a plus.

Under supervision, you will work with payer updates, maintain HIPAA compliance, and collaborate with internal teams to resolve issues and improve revenue cycle processes.