Denials & Appeals Specialist – Revenue Cycle

McLaren Health Care; Shelby Charter Township (MI); Sur place; USD 65 000 - 90 000; Plein temps

Résumé du poste

McLaren Health Care is seeking a Denials Management Specialist to ensure timely follow-up and appeals of denials from third-party payers. The role focuses on independent management of assigned work to meet filing deadlines and maximize reimbursement for services rendered.

Responsibilities include monitoring denial queues, investigating trends, assisting with audits, obtaining retro authorizations, and writing non-clinical appeals.

Qualifications

• High School Diploma or GED required.
• Associates Degree with 3 years of Patient Accounting or Patient Access experience required.
• 7 years experience in Patient Accounting or Patient Access experience if no degree.

Responsabilités

• Monitors denial work queues and reports in accordance with assignments from direct supervisor.
• Maintains required levels of productivity while managing tasks in work queues to ensure timeliness of follow-up and appeals.
• Tracks and investigates denial trends/ root cause.
• Assists with claim audits as necessary.
• Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.
• Obtain retro authorizations and submit to payers for reimbursement.
• Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.
• As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.
• Works independently with other departments to resolve A/R and payer issues.
• Participates in departmental and team meetings involving discussion of A/R processes and trends.
• Knowledge of payer edits, rejections, rules, and how to appropriately respond to each to resolution.

Formation

High School Diploma or GED

Associates Degree with 3 years of Patient Accounting or Patient Access experience

Description du poste

McLaren Health Care is seeking a Denials Management Specialist to ensure timely follow-up and appeals of denials from third-party payers. The role focuses on independent management of assigned work to meet filing deadlines and maximize reimbursement for services rendered.

Responsibilities include monitoring denial queues, investigating trends, assisting with audits, obtaining retro authorizations, and writing non-clinical appeals.