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Description

The Denial Specialist will undertake a variety of financial and non-financial tasks in order to help guarantee the company’s revenues and collect payments owed. They handle the processing of incoming payments along with the issuing of necessary paperwork including processing EOB’s and denials.

 

Become a Hopebridge Hero and help make a difference in the lives of families with children who have autism. We serve children of virtually all insurance types, commercial and Medicaid, and efficiently collecting payment for our services is the lifeblood for our sustained growth. We are specifically looking for driven and enthusiastic professionals with at least one year of experience in a medical or behavior health billing and collection environment, whether with a provider or a payer.

 

Responsibilities:

 

        Review insurance claims for accuracy and completeness, send electronically through the clearing house, and correct any rejections

        Post payments using our accounts receivable software, most often electronic remittances but also paper remits for smaller volume payers

        Review allowed amount and compare to expected amount, understand how to interpret variances, and apply adjustment codes per specific instructions with a very high degree of accuracy

        Research claims issues in our practice management software to provide missing or corrected information on claims that have been denied

        Work assigned denied/unpaid claims with follow up activity including portal refiling, filing appeals, phone disputes with insurance reps.  Maintain a minimum productivity level for claims resolution.

        Check each insurance payment is for accuracy and compliance with contract discount

        Identify and bill secondary or tertiary insurances and apply remaining balances when appropriate to the patient’s account.

        Escalate payer or system issues or compliance as they are encountered

        Identify overpayments and create refund requests

        Ensures all medical billing records are maintained according to HIPAA guidelines

        Demonstrates positive customer service and communication skills with payers, fellow employees, and patients’ families

        Other duties as assigned

        Knowledge of insurance guidelines especially Medicare and state Medicaid

 


Requirements:

        Minimum one year of experience as Billing Assistant, claims Processor or similar title

        Positive/competitive attitude toward minimum productivity standards and exceeding them.

        High degree of attention to detail and trustworthiness

        Office hours are between 8:00am- 5:00pm

        High School Diploma/GED

        Certification in Medical Billing & Coding preferred

 

Preferred Skills:

 

        Must be go-getter who is comfortable in a fast-paced environment that changes daily

        Must be pro-active and able to prioritize tasks

        Must be able to work with minimal supervision

        Strong computer skills including accurate data entry

        Experience with processing insurance claims

        Must be very comfortable working on the computer

        Willing to participate in staff development activities as assigned.

        Willing to observe and follow all agency and departmental philosophies, policies, procedures and the Agency Standards of Conduct and Code of Ethics.

        Must have reliable transportation

 

Physical Demands:

This is a stationary position that requires frequent sitting or standing, repetitive wrist motions, grasping, speaking, listening, close vision, color vision, and the ability to adjust focus.  It also may require occasional lifting, carrying, walking, climbing, kneeling, bending/stooping, twisting, pulling/pushing, walking, bending, stooping, and reaching above the shoulder.  Employees in this position must be physically able to efficiently perform the essential functions of the position. Reasonable accommodations will be provided to assist or enable qualified individuals with disabilities to perform the essential functions of the position, upon request.

 

Work Environment:

Work is performed in an office environment. Work may be stressful at times due to a busy office. Interaction with others is constant and interruptive.