CPC-Certified Denied Claims Specialist

Rhode Island Hospital; Providence (RI); On-site; USD 28,000 - 45,000; Full time

Job summary

Rhode Island Hospital in Providence, RI seeks a follow-up claims specialist to manage denied claims for a large physician multi-specialty practice. Under general supervision, you will review denials, correct and resubmit, and communicate with payers to resolve issues.

Experience with Epic is a plus and HIPAA compliance is essential. You will work Monday–Friday, 7:30–4, at our Corporate Headquarters location in Providence with a pay range noted in the posting.

Qualifications

• Equivalent to a high school graduate.
• Knowledge of 3rd party billing to include ICD, CPT, HCPCS and 1500 claim forms.
• Demonstrated skills in critical thinking, diplomacy and relationship-building.
• Highly developed communication skills, successfully demonstrated in effectively working with a wide variety of people in both individual and team settings.
• Demonstrated problem-solving and inductive reasoning skills which manifest themselves in creative solutions for operational inefficiencies.

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 specific 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

3rd party billing

Critical thinking

Communication skills

Relationship building

Education

High school diploma

Tools

Epic EHR

Job description

Rhode Island Hospital in Providence, RI seeks a follow-up claims specialist to manage denied claims for a large physician multi-specialty practice. Under general supervision, you will review denials, correct and resubmit, and communicate with payers to resolve issues.

Experience with Epic is a plus and HIPAA compliance is essential. You will work Monday–Friday, 7:30–4, at our Corporate Headquarters location in Providence with a pay range noted in the posting.