Denials Management Specialist- Revenue Integrity- Days - FT

Responsible for denial management and identifying areas of continued process improvements to ensure further decrease in new denials, final write off denials, and pre-bill denials. Works with Team Lead on process improvement opportunities. Coordinates with hospital and professional services billing and follow up teams, Health Information Management, Release of Information and coding; and maintains effective communication with all members of the healthcare team both internal and external.

Responsible for denial management and identifying areas of continuous process improvements. Resolves payment rejections, denials and validates denial reasons. Coordinates internal and external resources to overturn the rejections. Initiates and manages appeals as appropriate to obtain maximum reimbursement. Works with team leader and team members on process improvement opportunities. Evaluates denials to determine and track root cause and implement corrective actions. Identifies denial trends and provides information to the denial team to determine ways to prevent future unavoidable denials Validates accuracy of Provider and Carrier invoices per policy. Manages resolution of exceptions/issues. Prepares reports on audit results, process improvement recommendations, and systemic payment errors. Assists in the development of financial data collection and tracking tools to analyze data and prioritize denial trends.

Education: Associate's Degree Or high school diploma/equivalent with the required experience Experience: Two (2) years of experience (with Associate's degree) or 4 years of experience (with high school diploma/equivalent) in a revenue cycle role including billing and follow-up.