Denial Management & Claims Follow-Up Specialist

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

Job summary

Brown University Health in Providence, RI seeks a follow-up claims specialist to manage outstanding claims and correct denied claims for a large physician multi-specialty practice.

The role involves reviewing denials, communicating with payers, ensuring HIPAA compliance, and collaborating with internal departments to expedite adjudication. Monday–Friday, on-site at Corporate Headquarters.

Qualifications

• Equivalent to a high school graduate.
• Knowledge of 3rd party billing including ICD, CPT, HCPCS and 1500 forms.
• Demonstrated skills in critical thinking, diplomacy and relationship-building.
• Strong communication skills with diverse teams.
• Experience with Epic is a plus.

Responsibilities

• Review denied claims and correct them in the system; send corrected/appealed claims via written correspondence, fax or electronic submission.
• Identify and analyze denials; enact corrective measures to resolve payer errors.
• Stay updated on payer updates via lists, provider updates, webinars and websites.
• Maintain HIPAA compliance when handling patient information and gather missing information.
• Report denial trends to supervisor and assist in process improvements.
• Answer inquiries from 3rd party payers via phone; refer unusual requests to supervisor.
• Refer unresolved accounts to supervisor for further review.

Skills

ICD/CPT/HCPCS knowledge

Communication skills

Critical thinking

Relationship-building

Inductive reasoning

Education

High school diploma

1–3 years professional billing experience

Tools

Epic

Job description

Brown University Health in Providence, RI seeks a follow-up claims specialist to manage outstanding claims and correct denied claims for a large physician multi-specialty practice.

The role involves reviewing denials, communicating with payers, ensuring HIPAA compliance, and collaborating with internal departments to expedite adjudication. Monday–Friday, on-site at Corporate Headquarters.