Denials Management Specialist

mclarenhlth; Shelby Township (MI); On-site; USD 42,000 - 62,000; Full time

Job summary

McLaren Health in Shelby Township, MI seeks a Denials Management Specialist to ensure timely follow-up and appeals of denials from third-party payers. The role requires managing queues, identifying denial trends, and coordinating with departments to maximize payments for services rendered.

The ideal candidate has substantial experience in patient accounting or patient access, with strong knowledge of payer rules and timely submission of appeals. This is an on-site role based in Michigan.

Qualifications

• Seventh years of experience in Patient Accounting or Patient Access
• Strong denials management and payer appeal process
• Ability to work independently and manage queues

Responsibilities

• Monitor denial work queues and ensure timely follow-up.
• Track denial trends and investigate root causes.
• Assist with claim audits as needed.
• Communicate payer issues to management.
• Obtain retro authorizations and submit to payers.
• Prepare non-clinical appeals and ensure timely submissions.
• Participate in A/R clean-up and special projects.
• Collaborate with other departments to resolve A/R and payer issues.
• Attend departmental and team meetings on A/R processes and trends.
• Maintain knowledge of payer edits and rejection rules.

Skills

Denials management

Payer communications

Claims follow-up

Audits support

Independent worker

Education

High School Diploma or GED

Associates degree + 3 years experience

Tools

Billing software

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