Denials Management Specialist

McLaren Health Care; Shelby Township (MI); On-site; USD 55,000 - 75,000; Full time

Job summary

McLaren Health Care is seeking a Denials Management Specialist to manage timely follow-up and appeals of denials from third-party payers. You will work independently to ensure deadlines are met and maximize pay for services rendered.

The role requires 7 years in Patient Accounting or Patient Access, or an Associates Degree with 3 years of related experience, with a standard schedule of 8am–4:30pm, on-site in Michigan. Collaborative work with billing teams is essential to improve A/R outcomes.

Qualifications

• High School Diploma or GED required.
• 7 years of experience in Patient Accounting or Patient Access.
• Alternatively, an Associates Degree with 3 years of Patient Accounting or Patient Access experience.

Responsibilities

• Follow up on denials and appeals to meet payer filing deadlines.
• Monitor denial work queues and maintain productive workflow.
• Investigate denial trends and root causes; report findings.
• Assist with claim audits and remedial actions as needed.
• Obtain retro authorizations and submit to payers for reimbursement.
• Work with other departments to resolve A/R and payer issues.
• Participate in meetings to discuss A/R processes and trends.

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

• 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.

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
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No