Rejection and Denial Specialist (Remote)

NAPA Management Services Corporation; United States; Remote; USD 26,000 - 30,000; Full time

Benefits offered by this job

Paid Time Off

Health insurance

Dental insurance

Vision care

Disability insurance

AD&D insurance

401(k)

Job summary

North American Partners in Anesthesia is seeking a Rejections and Denials Specialist in Sunrise, FL to manage denied eligibility claims across payers and states. The role requires reviewing plans, updating accounts, and identifying payer-related denial trends while maintaining HIPAA compliance.

You will work in multiple queues, contact payers by phone or online, and collaborate with team leads to improve processes. Generous benefits and growth opportunities are offered.

Qualifications

• High school diploma or equivalent.
• 3+ years of eligibility knowledge.
• Familiar with Medicare/Medicaid, HMOs and PPOs.
• 3+ years of denials management experience.
• Strong communication and multitasking abilities.

Responsibilities

• Analyzes patient insurance to identify correct plan selection.
• Documents steps to ensure accounts are worked correctly.
• Troubleshoot and resolve issues to prevent errors.
• Contact payers, offices, or patients to obtain information.
• Assist management in optimizing eligibility team efficiency.
• Train and educate new and established staff.

Skills

Eligibility knowledge

Denials management

Customer service

MS Word Excel

Education

High school diploma

Job description

Sunrise,FL - USA Rejections and Denials Specialist

Position Requirements The Rejections and Denials Specialist will be responsible to work the denied eligibility claims for all assigned payers and states. This will include working within multiple work queues, contact payers online or by phone, updating accounts as needed, and identifying carrier-related denial trends. This position will need to maintain a thorough knowledge and understanding of all charge corrections and FSC transfers, on top of understanding the differences. Familiarity with anesthesia modifiers, procedure codes and diagnostic codes. In addition, there may be projects that may require a manual process by reviewing and working off spreadsheets.

PRIMARY RESPONSIBILITIES:

Analyzes patient insurance to identify the correct insurance plan(s) was selected by reviewing the plan selection and any necessary documents or payor portals. Accurately documents all the proper steps to ensure accounts are worked correctly in a timely manner. Has the able to troubleshoot and resolve issues before they occur by collecting all the appropriate information to create useful error output Identifies billing errors and charge correction errors through research to resolve claim errors in a timely manner for the more complex eligibility tasks. This could include contacting payers, referring office/hospital, or patients to obtain medical insurance information. Follow the department directions, TIP sheets, procedure manuals, and departmental policy and procedures. Evaluate insurance payor set up with the billing system to confirm the eligibility payor connection logic. Assist management in optimizing the efficiency and quality of eligibility team. Assist with training and educating new and established staff members.

QUALIFICATIONSREQUIRED QUALIFICATIONS:

High school diploma or equivalent certification required

3 plus years of experience with eligibility related knowledge Knowledge of understanding guidelines for Medicare/Medicaid, government plans, HMOs, and PPOs At least one year of exceptional customer service skills 3 plus years of denials management experience Strong computer skills (including MS Word and Excel) Ability to think critically and resolve accounts with minimal supervision Has a strong working knowledge of billing procedures, insurance reimbursement and guidelines preferably in a medical or anesthesia setting Ability to multitask, work in a team as well as independently Must be able to communicate effectively and professionally to patients, insurance companies along with co-workers and management Strong oral and written communication skills preferred Ability to perform at a high level of productivity and quality Work in collaboration with Team Lead to improve processes Ability to ensure confidentiality of sensitive information and maintain HIPAA compliance. Exceptional organization and time management skills Must have professional and effective oral communications with co-workers, insurance representatives, clients, and patients

Generous benefits package, including: Paid Time Off Health, life, vision, dental, disability, and AD&D insurance Flexible Spending Accounts/Health Savings Accounts 401(k) Leadership and professional development opportunities

North American Partners in Anesthesia is an equal opportunity employer. North American Partners in Anesthesia (NAPA) has evolved through more than 30 years to become a leader in anesthesia and perioperative services. Single specialty and clinician led, we remain committed to our mission of delivering exceptional patient experiences, every day. At NAPA, we cultivate leaders, promote work-life balance, and celebrate diversity. We know your success promotes our success, and we give you the tools and programs to achieve your goals. With flexibility, a collegial and collaborative environment, a wide range of market-leading benefits, and career opportunities from coast-to-coast, your future is waiting at NAPA.

Total Rewards Salary: $19-22 hourly