Medical AR Follow-up & Denial Specialist - Remote

NEW HIRE ORIENTATION STARTS APRIL 23RD

The Medical AR Follow-up & Denial Specialist is primarily responsible for analyzing and resolving all insurance claim denials for DME Supplies. The individual in this position will generate effective written appeals to carriers using well-researched logic in order to recoup reimbursement on incorrectly denied claims.  Appeal carrier denials through coding review, contract review, medical record review, and carrier interaction.  Utilize a multitude of resources to ensure correct appeal processes are followed and completed in a timely manner.  Demonstrate a high level of expertise in the management of denied claims and deploy an analytical approach to resolving denials while recognizing trends and patterns in order to proactively resolve recurring issues. Communicate identified denial patterns to management.  Prioritize and process denials while maintaining high quality of work.  Serve as an escalation point for unresolved denial issues.  Inform team members of payer policy changes.  Assist in educating employees when needed.  Collaborate on special projects as needed. Assist manager of additional tasks as needed.

Essential Responsibilities and Tasks:

• Reviews denied claims to ensure coding was appropriate and make corrections as needed.
• Ensures billing and coding are correct prior to sending appeals or reconsiderations to payers.
• Investigate claims with no payer response to ensure claim was received by payer
• Strong understanding of payer websites and appeal process by all payers including commercial and government payers including Medicare, Medicaid, and Medicare Advantage plans
• Reviews and finds trends or patterns of denials to prevent errors
• Assists and confers with coder and billing manager concerning any coding problems.
• Strong research and analytical skills. Must be a critical thinker.
• Stays current with compliance and changing regulatory guideline.
• Demonstrates knowledge of coding and medical terminology in order to effectively know if claim denied appropriately and if appeal is warranted.
• Supports and participates in process and quality improvement initiatives.
• Achieve goals set forth by supervisor regarding error-free work, transactions, processes and compliance requirements.

Position Type:

This is a full-time 40 hour work week. Monday -Friday day shift.  Occasional evening and weekend work may be required as job duties demand

Required Education and Experience:

• Three or more years of DME billing/coding experience is required.
• Collections of insurance claims experience.
• Medicare and/or Medicaid background.
• Durable Medical Equipment (DME) experience.
• EDI transmission experience preferred.
• High school diploma or GED diploma  

***** EQUIPMENT IS NOT PROVIDED, YOU MUST HAVE YOUR OWN COMPUTER.

 Other Duties:

All other duties as assigned by management.  Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are request of the employee for this job.  Duties, responsibilities, and activities may change at any time with or without notice.