Denials Management Specialist

Socket.dev; Shelby Charter Township (MI); On-site; USD 52,000 - 76,000; Full time

Job summary

Socket.dev in the United States is hiring a Denials Management Specialist to ensure timely follow-up and appeals of denials and rejections from third-party payers. The role emphasizes independent work and meeting payer filing deadlines to maximize reimbursement.

You will monitor denial queues, analyze trends, assist with audits, and collaborate with billing teams to resolve A/R issues and respond to payer requests with accurate, non-clinical appeals.

Qualifications

• 7 years experience in Patient Accounting or Patient Access
• Associates Degree with 3 years of Patient Accounting or Patient Access experience

Responsibilities

• Monitors denial work queues and reports in accordance with assignments from direct supervisor.
• Tracks and investigates denial trends/root causes.
• Assists with claim audits as necessary.
• M isks changes in billing systems, insurance carriers, and/or network to management.
• Obtains retro authorizations and submits to payers for reimbursement.
• Writes non-clinical appeals with timely and successful submissions.
• Works independently with other departments to resolve A/R and payer issues.
• Participates in departmental and team meetings discussing A/R processes and trends.

Skills

Patient Accounting experience

Patient Access experience

Denials management

Education

High School Diploma or GED

Associates Degree

Job description

Position Summary:

The Denials Management Specialist is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The specialist will work independently while managing their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered.

Essential Functions and Responsibilities as Assigned:

1. 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.

2. Tracks and investigates denial trends/ root cause.

3. Assists with claim audits as necessary.

4. Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.

5. Obtain retro authorizations and submit to payers for reimbursement.

6. Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.

7. As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.

8. Works independently with other departments to resolve A/R and payer issues.

9. Participates in departmental and team meetings involving discussion of A/R processes and trends.

10. Knowledge of payer edits, rejections, rules, and how to appropriately respond to each to resolution.

Qualifications:

Required:

• High School Diploma or GED
• 7 years experience in Patient Accounting or Patient Access experience

OR

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