Denials Management Specialist

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

The McLaren system includes 12 hospitals across the state, ambulatory surgery centers, imaging centers, a 730-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 242,000 Michigan lives, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network, and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer center. McLaren has 20,000 full-, part-time and contracted employees and more than 93,000 network providers throughout Michigan.

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

Additional Information

• Schedule: Full-time
• Requisition ID: 26010355
• Daily Work Times: 8am - 4:30pm
• On Call: No

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.

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McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employmentwithout regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status,national origin, disability, genetic information, height or weight, protected veteran or other classificationprotected by law.