Insurance and Denials Specialist

POSITION SUMMARY

Under the direction and support of the Insurance and Denials Manager, the Insurance and

Denials Specialist will initiate billing claims, actively process all denials, and ensure follow up on collection efforts to ensure timely reimbursement for services provided.

The Insurance and Denials Specialist require critical thinking skills, ability to identify

trends, and achieve departmental revenue goals. We are looking for someone who can

confidently gather the required information to submit and resolve health insurance claims

to multiple payers.

SUPERVISION RECEIVED

Insurance and Denials Manager

DIRECT REPORTS

Director of Compliance

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty

satisfactorily.

• Registration of patients, insurance verification, HCPCS coding and ICD-10 coding
• Verify all insurance orders for accuracy and completeness
• Review clinical documentation to ensure compliance with payors guidelines
• Apply correct modifiers and HCPCS to claims
• Communicate with Gentell clinicians and customer facilities as needed to expedite claims processing
• Transmit/submit claims (paper or electronic) to insurance payors for reimbursement
• Contact insurance companies on outstanding claims
• Maintain supporting chronological notes that detail actions taken to resolve outstanding account balances
• Resolve insurance problems and patient issues that may have resulted from incorrect or incomplete information
• Review received insurance payments for underpayment
• Call insurance companies regarding any discrepancy in payments as needed
• Process all appeal requests within the time frame required
• Process approved adjustments
• Maintain patient demographic information and data collection systems, including all billing/collection reports, queues, or diversions while remaining in accordance with payor and company policy guidelines
• Research and resolve discrepancies, denials, and appeals. Use initiative and critical thinking to identify problems, recommend solutions to management, and set priorities.
• Perform miscellaneous job-related duties as assigned

DESIRED MINIMUM QUALIFICATIONS

The requirements listed below are representative of the knowledge, skill and/or ability required for this position.

• High school diploma or GED required; Associate degree preferred
• 2 years minimum experience in healthcare insurance billing, collections, and/or denials and appeals
• Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems
• Thorough knowledge of all private insurance rules and regulations as it relates to claims submission and/or denials and appeals
• Knowledge of LCDs, Medicare Guidelines for DME, supplier standards for DME
• Must be able to work effectively with patients/customers, company staff, and outside parties, such as insurance company representatives
• Strong customer service orientation
• Ability to work in strong collaboration with all internal and external team members, inside and outside of the Revenue Cycle department
• Strong attention to detail and accuracy
• Task oriented while performing in a fast-paced environment
• Certification in Medical Billing/Coding a plus
• 1 year of Durable Medical Equipment billing experience preferred
• Experience with wound care orders billing a plus
• Knowledge of Brightree a plus

Pay: $23.00 - $25.00 per hour

Work Location: In person