Denials Specialist, RCM

Mayfield Brain & Spine; Cincinnati (OH); On-site; USD 42,000 - 56,000; Full time

Job summary

Mayfield Brain & Spine is seeking a Claims Follow-Up Specialist to join the Revenue Cycle Management team. You will process insurance remittances, follow up on denials, and manage accounts receivable with focus on timely reimbursement.

The role requires strong attention to detail, empathy, and the ability to adapt in a dynamic healthcare environment. Two years in healthcare admin/RCM plus HS diploma are expected.

Qualifications

• Requires a High School Diploma and at least two years in healthcare administration or revenue cycle.
• CRCR certification is preferred but not required.

Responsibilities

• Execute follow-up actions on insurance claims to expedite cash flow.
• Resolve denials and handle follow-up with payers in assigned area.
• Maintain documentation and update the practice management system.
• Prioritize claims by aging and dollar value; contact payers as needed.
• Process appeals, corrections, remittances, and takeback requests when required.

Skills

Customer service

Empathy

Problem solving

Multitasking

Communication

Composure

Judgment

Teamwork

Computer skills

Self-motivation

Education

High School Diploma

Two years' experience in healthcare administration/revenue cycle

CRCR Certification preferred

Job description

This Specialist will join the claims follow-up team and be responsible for processing insurance company remittances, denial follow-up, and other tasks related to insurance claim accounts receivable. The Revenue Cycle Management (RCM) team is looking for someone with insurance claims denials follow-up experience, plus critical thinking skills, attention to detail, and the ability to learn quickly and adapt to a changing environment.

Education/Experience

• High School Diploma required
• Two years' experience in healthcare administration/revenue cycle
• CRCR Certification preferred

Skills

• Demonstrates excellent customer service
• Ability to convey empathy
• Strong problem-solving, problem-prevention, and decision-making skills
• Ability to manage and prioritize multiple tasks in fast-paced environment
• Excellent oral and written communication skills
• Ability to maintain composure and restore calm in a stressful situation
• Uses good judgment and diplomacy when dealing with others
• Desire and ability to work in a team environment
• Computer proficient with the ability to learn multiple software applications
• Ability to work with minimal supervision

Primary Responsibilities

The purpose of this position is to execute follow-up actions on insurance claims; expedite positive cash flow, maximize reimbursement, and resolve claims denials and issues with payers in the assigned area of the Revenue Cycle claims process.

Essential Functions

• Help develop &maintain a corporate culture that supports the mission and values of Mayfield Clinic
• Follow up on submitted electronic & hard copy claims in an accurate, timely manner; submit appeals, make corrections to overturn denials, post payments, & process takeback requests as required.
• Make all necessary corrections to claims that do not pass billing edits/payer requirements & resubmit to payers.
• Contact payers regarding unpaid claims. Research and/or ensure that questions and requests for information are addressed in a timely & professional manner to ensure resolution & reimbursement.
• Ensure timely & accurate posting of remittance advice information & follow up as needed to ensure full, expected reimbursement for services provided.
• Maintain documentation and update our practice management system for appropriate claims submission & other pertinent information to identify action taken.
• Make necessary adjustments as appropriately required by plan reimbursement & company policy.
• Prioritize claims based on aging and outstanding dollar amounts or as directed by management.
• Research & initiate requests for refunds for accounts with credit balances.
• Answer & initiate phone inquiries regarding bills, charges, claims, and account status.
• Update data in the practice management system as required.
• Contribute to the team environment by performing other duties as assigned.

Physical Requirements

• Hand Movement, including repetitive motions, grasping, holding, and finger dexterity. Reading, Writing, and Hand-Eye Coordination. Vision, including color distinction, and visual inspection. Hearing, Talking, Sitting, Lifting up to 10 pounds, Bending, Reaching

Mayfield Clinic Mission

• Superior clinical outcomes
• Compassionate patient care
• Education and research
• Innovation

Mayfield Clinic Values

• Integrity: We commit to honest and ethical behavior in all of our endeavors and interactions.
• Excellence: We commit to the highest level of performance and continuous improvement.
• Respect: We embrace the importance of all individuals & value their diverse backgrounds, skills & contributions.
• Compassion: We commit to being compassionate and empathetic in all of our interactions.
• Collaboration: We embrace teamwork, mentoring, cooperation, sharing of expertise, & empowerment.