Denials Specialist

Job Description

• Denials Specialist is responsible for correction of all denied claims.
• Does not bill on CPT Codes - they charge a flat rate per use, so most of the work is done in excel and not EMR.
• Heavy communication with the payers and this requires high level of critical thinking and analytical skills - this is not a basic denials job!
• Go to various portals (Athena - claims) or Payer protals -- go to payer portal to find out why it has been denied
• Go internal and find the revenue cycle specialist that works with THAT payer to get the claims paid out
• Determine WHY it was denied - copays, deductibles, wrong service, wrong codes - split unpaid amounts into various buckets based on the cause of the denial - and work with the internal revenue cycle specialist to correct
• Then re-submit the claim to the payer
• Most of this will be in Excel within google sheets

Qualifications

• Min 6 months years experience in denials management
• Very comfortable working on a mac, not a pc
• Know how to use payer portals to pull denial reports and resubmit information - strong relationship-building skills, particularly in working directly with payer contacts
• Able to diagnose why a claim was denied and do internal research to solve the problem
• Excel & google sheets - know formulas, sort, filter - will train on v look ups and pivot tables