Denial Collections Specialist

Denial Collections Specialist

Requirements

• High School Diploma/GED
• 1 year Patient Accounting Required

Responsibilities

• Reports and uses software to track, trend and identify root causes of denials; offers suggestions for process improvement to resolve denial issues, supported by documentation and data.
• Collaborates with other departments to align interdepartmental functioning, goals, and expectations.
• Conducts follow-up with insurance carriers, physicians, and other stakeholders that can validate and assist with actions and information needed in order to properly review, dispute, or appeal denial until a determination is made to conclude the appeal.
• Completes write-offs per policy and/or reassign remaining balances to respective departments.
• Ensures that follow-up responses on denied claims occur on a timely basis and adhere to contractually binding conditions.
• Resubmits upheld denials as warranted, and monitors denial resubmissions for payment. Resubmits claims using the denial program re-bill requests feature, ensuring all modifications to the account are reflected on the claim form.
• Performs reconsiderations and appeals on Payor websites or with appropriate Payor required documentation.
• Ensures compliance with all state and federal billing regulations. Reports any suspicious activities to leadership.
• Performs recoupments to include investigating claim and payment history to see if the appeal is warranted.
• Collects documentation and submits write-off if appropriate.
• Rejected Claim Review Reviews rejected claims based on NPI denials (ABO Only).

Preferred Qualifications

• Preferred Associate’s Degree