Medical Billing Professional Denial Specialist

Rhode Island Hospital; Providence (RI); On-site; USD 28,000 - 45,000; Full time

Job summary

Rhode Island Hospital is seeking an experienced claims follow-up specialist to correct denied claims for a large physician multi-specialty practice. The role emphasizes accuracy, HIPAA compliance, and timely resolution of payer issues in a collaborative environment.

Under supervision, you will review denials, gather supporting documentation, and communicate with payers to resolve discrepancies ensuring efficient adjudication and quality service for patients and providers in Providence, RI.

Qualifications

• One to three years of professional billing experience.
• Epic experience is a plus.
• Knowledge of ICD, CPT, HCPCS and 1500 claim forms.

Responsibilities

• Review all denied claims, correct them in the system and send corrected/appealed claims.
• Identify and analyze denials and enact corrective measures with payers.
• Maintain HIPAA compliance when handling patient information.
• Contact internal departments to obtain missing or erroneous information on a claim.
• Report denial trends to improve revenue delays.
• Answer inquiries from 3rd party payers and route unusual requests as needed.
• Retrieve medical records documentation for third party requests.

Skills

Critical thinking

Diplomacy

Relationship-building

Communication skills

Teamwork

Education

High school diploma

Tools

Epic

Job description

SUMMARY:

Under general supervision of the Follow-up Supervisor, performs all duties necessary
to follow up on outstanding claims and correct all denied claims for a large
physician multi-specialty practice.

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:

• Instill Trust and Value Differences
• Patient and Community Focus and Collaborate

RESPONSIBILITIES:

• Review all denied claims, correct them in the system and send correctedppealed claims asbr / written correspondence, fax or via electronic submission.


• Identify and analyze denials and enact corrective measures as needed to effectivelybr / communicate and resolve payer errors.


• Continually maintain knowledge of payer specific updates via payer's listservs, providerbr / updates, webinars, meetings and websites.


• Understand and maintain compliance with HIPAA guidelines when handling patient information


• Contact internal departments to acquire missing or erroneous information on a claimbr / resulting in adjudication delays or denials.


• Report to supervisor identification of denial trends resulting in revenue delays.


• Answers telephone inquiries from 3rd party payers; refer all unusual requests tobr / supervisor.


• Retrieve appropriate medical records documentation based on third party requests.


• Refer all accounts to supervisor for additional review if the account cannot be resolvedbr / according to normal procedures.


• Work with management to improve processes, increase accuracy, create efficiencies andbr / achieve the overall goals of the department.


• Maintain quality assurance, safety, environmental and infection control in accordancebr / with established policies, procedures, and objectives of the system andbr / affiliates.


• Perform other related duties as required.

MINIMUM QUALIFICATIONS:

BASIC KNOWLEDGE:

Equivalent to a high school graduate.

Knowledge of 3rd party billing to include ICD, CPT, HCPCS and 1500 claim forms.

Demonstrated skills in critical thinking, diplomacy and relationship-building.

Highly developed communication skills, successfully demonstrated in effectively working with a wide variety of people in both individual and team settings.

Demonstrated problem-solving and inductive reasoning skills which manifest themselves in creative solutions for operational inefficiencies.

EXPERIENCE:

One to three years of relevant experience in professional billing preferred.

Experience with Epic a plus.

INDEPENDENT ACTION:

Incumbent generally establishes own work plan based on pre-determined priorities and standard procedures to ensure timely completion of assigned work. Problems needing clarification are reviewed with supervisor prior to taking action.

SUPERVISORY RESPONSIBILITY:

None

Pay Range: $19.97-$32.96

EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location: Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903

Work Type: Monday-Friday 7:30-4

Work Shift: Day

Daily Hours: 8 hours

Driving Required: No