EHPB Denial Management Spec

EvergreenHealth; Kirkland (WA); On-site; USD 45,000 - 72,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

Dental insurance

Health Savings Account (HSA)

Flexible Spending Account (FSA)

Life and disability insurance

Retirement plans

Tuition assistance

Paid Time Off

Job summary

EvergreenHealth is seeking a Denials Analyst to investigate health plan denials and determine the appropriate action and resolution. Responsibilities include correcting claims, rebilling, and coordinating appeals with payors, while tracking outcomes and identifying denial patterns for process improvements.

The role requires understanding of CPT/Modifiers/HCPC/ICD-10 codes, one year of professional billing experience, and Ten-key by touch. College degree or vocational training is desirable.

Qualifications

• High School graduate or equivalent.
• 1-year previous experience in professional billing.
• Knowledge and experience with health care insurers and their reimbursement systems, especially Medicare, Medicaid, Workers Compensation, Motor Vehicle and contract payers.
• A good understanding of CPT, Modifiers, HCPC, ICD-10 codes and medical terminologies.
• Demonstrated problem solving ability.
• Ten-key by touch

Responsibilities

• Investigates insurance denials to identify action necessary.
• Corrects claims based on denials, complaints and audits and rebills using payor approved process.
• Determines need for payor appeal and sends individualized appeal letter.
• Monitors appeals for resolution.
• Adjusts denials determined to be appropriate using the corresponding adjustment code(s).
• Works the accounts that meet denial management criteria and coordinates resolution with other departments.
• Denial management criteria include accounts that have potential financial impact such as authorization and refer denials, bundling issues and medical necessity for all assigned payers.
• Logs all denials including actions and resolution on Denial spreadsheet.

Skills

Billing experience

Denial management

Problem solving

Ten-key by touch

Education

High School diploma

College degree or vocational training

Job description

Wage Range: $21.52 - $34.43 per hour

Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.

Job Summary:

Investigates health plan denials to determine appropriate action and provide resolution.

Primary Duties:

• 1. investigates insurance denials to identify action necessary.
• 2. Corrects claims based on denials, complaints and audits and rebills using payor approved process.
• 3. Determines need for payor appeal and sends individualized appeal letter. Monitors appeals for resolution
• 4.. Adjustsdenials determined to be appropriate using the corresponding adjustment code(s).
• 5. Works the accounts that meet denial management criteria and coordinates resolution with other departments. Denial management criteria include accounts that have potential financial impact such as authorization and refer denials, bundling issues and medical necessity for all assigned payers.
• 6. Logs all denials including actions and resolution on Denial spreadsheet.
• 7. Identify denial pattern to identify potential process improvement.
• 8. Produces quarterly denial reports.

License, Certification, Education or Experience:

REQUIREDfor the position:

• High School graduate or equivalent.
• 1-year previous experience in professional billing.
• Knowledge and experience in working with health care insurers and their reimbursement systems, especially Medicare, Medicaid, Workers Compensation, Motor Vehicle and contract payers.
• A good understanding of CPT, Modifiers, HCPC, ICD-10 codes and medical terminologies.
• Demonstrated problem solving ability.
• Ten-key by touch

DESIREDfor the position:

• College degree/Vocational training in billing or business

Benefit Information:

Choices that care for you and your family

At EvergreenHealth, we appreciate our employees’ commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

• Medical, vision and dental insurance
• On-demand virtual health care
• Health Savings Account
• Flexible Spending Account
• Life and disability insurance
• Retirement plans (457(b) and 401(a) with employer contribution)
• Tuition assistance for undergraduate and graduate degrees
• Federal Public Service Loan Forgiveness program
• Paid Time Off/Vacation
• Extended Illness Bank/Sick Leave
• Paid holidays
• Voluntary hospital indemnity insurance
• Voluntary identity theft protection
• Voluntary legal insurance
• Pay in lieu of benefits premium program
• Free parking
• Commuter benefits