Denials Specialist, RCM

mayfieldclinic; Cincinnati (OH); On-site; USD 42,000 - 62,000; Full time

Job summary

Mayfield Clinic in Cincinnati is seeking a Specialist to join the claims follow-up team, handling insurance remittances, denial follow-up, and other accounts receivable tasks.

The role requires two years in healthcare revenue cycle, a High School Diploma, and strong customer service, written and verbal communication, and critical thinking. CRCR certification is preferred and the candidate should learn quickly and adapt to change in a fast-paced environment.

Qualifications

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

Responsibilities

• Follow up on submitted claims and take corrective actions to overturn denials.
• Submit appeals and post payments; process takeback requests.
• Research and contact payers regarding unpaid claims.
• Ensure timely posting of remittance advice and update practice management system.
• Prioritize aging claims and manage refunds for credit balances.
• Provide customer service and communicate with patients/clients.

Skills

Customer service

Empathy

Problem solving

Multi-tasking

Communication

Teamwork

Computer literacy

Self-motivation

Education

High School Diploma

Healthcare revenue cycle experience (2 years)

CRCR Certification preferred

Tools

Practice management software

Multiple software applications

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.