Denials Management Specialist

Baptist Health - Central Alabama; Montgomery (AL); On-site; USD 42,000 - 65,000; Full time

Job summary

Baptist Health - Central Alabama is seeking a Denials Management Specialist to validate dispute reasons, escalate variances to management, and generate appeals for denied or underpaid claims. The role entails resolving complex and aged accounts, researching payer contracts and regulations, and documenting collection activity.

The position requires knowledge of ICD-9/ICD-10 and CPT coding, plus strong MS Office skills, analytical abilities, and effective communication.

Qualifications

• High School diploma or equivalent required.
• Associates degree or higher preferred.
• Minimum of 3 years’ experience in hospital billing or medical office environment performing billing and/or collections.
• CRCR or CPAR certification preferred

Responsibilities

• Validate dispute reasons and escalate payment variance trends to management.
• Generate appeals for denied or underpaid claims.
• Resolve complex and aged accounts and review payer contracts and chargemaster.
• Document all pertinent collection activity accurately.
• Escalate issues to payer provider advocates and contracting teams as needed.

Skills

MS Office

Team leadership

Analytical thinking

Communication skills

Organization

Problem-solving

Education

High School diploma or equivalent

Associates degree or higher preferred

Tools

Billing software

ICD-9/ICD-10

CPT coding

Job description

Baptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties.

To learn more about Baptist Health, visit us at https://www.baptistfirst.org.

Highlights

Summary

The Denials Management Specialist shall be responsible to validate dispute reasons, **escalate payment variance trends or issues to management**, and generate appeals for denied or underpaid claims. This individual will resolve complex and aged accounts. Resolution of accounts may include research of payer and governmental regulations and billing rules, payment research, review of all aspects of the claim such as member information, CPT and diagnosis codes, review of medical records, analysis of managed care contracts and review of the chargemaster. The Specialist will have in-depth knowledge of payer contracts, billing rules, and administrative guidelines in order to effectively review and analyze denials and underpayments. The Specialist will provide meaningful feedback and recommendations to Managed Care, Revenue Integrity, and leadership teams regarding any trends or issues and will **escalate** as needed through payer provider advocates and contracting teams. Additionally, this individual will work collaboratively with other areas in attempts to resolve or minimize ongoing denials and underpayments. The Specialist will accurately and thoroughly document all pertinent collection activity performed. This position may have additional duties assigned that are within scope of the role.

Education

High School diploma or equivalent required. Associates degree or higher preferred. Minimum of at least 3 years’ experience in a hospital business or medical office environment performing billing and/or collections.

License/ Certifications

CRCR or CPAR certification preferred

Knowledge/ Skills/ Abilities

Excellent knowledge of MS Office and familiarity with relevant computer software. Strong team leadership skills, strong organization, interpersonal, and customer relations skills. Must be able to meet strict deadlines. Strong analytical and problem-solving ability, and excellent organizational skills. Must be able to complete multiple tasks simultaneously. Ability to remain calm in difficult situations. Strong written and oral communication skills, proficient computer skills, proven track record of successful performance. Ability to understand complex multifactor situations and bring appropriate solutions. Ability to work both independently and in a team environment. Knowledge of ICD-9, ICD-10, and CPT coding.

Primary Location:

Corporate

Job

Denials Management Specialist

Denials Management Specialist

Job Type

Regular-Full time

Shift

First Shift (United States of America)