Denial Resolution & Appeals Specialist

Altru Health System; Grand Forks (ND); On-site; USD 24,000 - 35,000; Full time

Benefits offered by this job

Health plan

401(k) retirement plan

Dental plan

Vision plan

Life insurance

Disability insurance

Education assistance

Paid time off

Job summary

Altru Health System in Grand Forks, ND seeks a Denial Management Specialist to manage and file appeals to reverse denials, coordinate with departments, and monitor payer guidelines. The role focuses on RAC account monitoring, denial trend analysis, and ensuring accurate adjustments while adhering to privacy standards.

Requirements include a minimum of 2 years related experience, strong communication, and ongoing payer policy education to support leadership and Patient Financial Services.

Responsibilities

• Manages and file appeals to reverse denials wherever possible.
• Works on assigned denials and appeals by collaborating with departments to resolve issues and identify trends.
• Stays updated on payer guidelines and requirements for denials and appeals.
• Monitors RAC accounts for AB rebills and post recovery or denial adjustments as needed.
• Identifies and address issues from denials to prevent future claim problems and analyzes denial trends and issues as assigned.
• Exhausts all appeal efforts based on dispute reasons and payer guidelines.
• Provides feedback and recommendations to leadership on trends, escalating issues when necessary.
• Participates in continuing education on payer and governmental policies, sharing updates with leadership and Patient Financial Services.
• Monitors appeals for resolution and adjust accounts using correct denial codes and recognizes when to elevate unresolved denials.
• Maintains strict confidentiality and adheres to all employer and government privacy standards, e.g., 42 CFR part 2 and HIPAA
• Performs other duties as assigned or needed to meet the needs of the department/organization.

Job description

Altru Health System in Grand Forks, ND seeks a Denial Management Specialist to manage and file appeals to reverse denials, coordinate with departments, and monitor payer guidelines. The role focuses on RAC account monitoring, denial trend analysis, and ensuring accurate adjustments while adhering to privacy standards.

Requirements include a minimum of 2 years related experience, strong communication, and ongoing payer policy education to support leadership and Patient Financial Services.