Customer Support and Denial Specialist

We are seeking a skilled and dedicated Customer Support & Denial Specialist to join our healthcare team. Professional Medical Management (PMM) supports Iowa Radiology, a patient-centered practice that promotes a more compassionate approach to medicine. We provide our employees the ability to bring their authentic selves to work every day, providing compassionate care for our patients in a collaborative, supportive work environment.

We want YOU to join the Iowa Rad family!

We truly care about our employees, their health and well-being, and their career goals and aspirations. The ideal Customer Support & Denial Specialist will play a crucial role in helping us continue to be the premier provider of radiologic services in Iowa by resolving claim denials, following up on outstanding claims, and providing outstanding service to our patients.

Position Details

• Department: Accounting/Finance
• Reports to: Billing Manager
• Schedule: Full-time, normal office hours (Monday through Friday)
• Location: PMM office or home office

Responsibilities of the Customer Support & Denial Specialist:

Denials

• Work denied claims from the Denial Tickler and decide on the action needed for resolution.
• Determine whether a denial is justified, and document the finding, move the balance to patient responsibility, or refer it to the Team Lead or Billing Manager for adjustment or write-off approval.
• Prepare and submit appeals when needed, and understand the levels of appeal and process for each insurance carrier.
• Contact carriers by email, web inquiry, or phone to gather additional information.
• Correct and refile claims (insurance policy IDs, prior authorization information, etc.). Coding changes (CPT/ICD-10/modifier) must be approved by a certified coder.
• Request insurance information, medical necessity documentation, records, or orders from ordering provider offices.
• Track timely filing and appeal deadlines and prioritize work accordingly.
• Track and communicate carrier-specific requirements and denial trends to the Billing and Coding managers.

Follow-Up

• Investigate outstanding claims from the tickler queue using carrier websites and phone contact, and take action to resolve issues preventing processing.
• Provide credit balance information to the refund department when necessary.
• Provide payment posters with documentation to post insurance responses when appropriate.

Customer Support

• Assist patients with account inquiries by phone, mail, email, and voicemail.
• Process credit card payments in accordance with PCI requirements.
• Provide price quotes and billing expectations for upcoming appointments, including good faith estimates for self-pay or uninsured patients.
• Set up reasonable payment plans and help patients execute payment methods.
• Work with clinic staff to answer billing and balance inquiries in the patient-facing clinics.

EDI and Administrative

• Review electronic claim rejections, research the rejection message, make necessary changes, and rebill the services.
• Review pre-eligibility checks and verify that suggested charges are appropriate.
• Review return mail from patients and insurance companies and take action based on protocols.
• Review, document, distribute, resolve, and scan miscellaneous incoming mail and fax correspondence.
• Review health insurance claim forms (CMS-1500/UB-04) and attachments for accuracy.
• Scan and index documentation into the document management system.

Other Functions

• Work as a collaborative team member with others in the billing office to complete billing processes timely and efficiently.
• Attend staff meetings and education workshops/training.
• Report problems related to staffing, morale, work methods, and procedures to the Billing Manager.
• Perform other duties as assigned.

Qualifications of the Customer Support & Denial Specialist:

Education

• High school diploma or equivalent (GED) required.

Knowledge, Skills, and Abilities

• Minimum of two (2) years of billing and insurance experience required.
• Knowledge of CPT and ICD-10 coding, modifiers, and insurance specifications preferred.
• Experience with email, internet, and Microsoft Office products.
• Must be able to read, write, and speak fluent English.
• Ability to communicate effectively with both internal team members and external customers.
• Excellent organizational skills and the ability to multi-task and make quick but accurate decisions.

Physical, Mental, and Visual Effort

• Continuous speaking, hearing, and visual effort.
• Must have the ability to communicate effectively and work independently.
• Continuous mental and visual concentration requiring attention-to-detail and accuracy.
• Working conditions are typical to a normal office or individual home office environment.
• Must possess manual dexterity to operate computer and other office equipment.
• Ability to perform repetitive tasks associated with technology use (phone, computer, applications, and software).
• Must be able to bend, stoop, kneel, or crouch as part of job functions.
• Ability to lift and carry up to twenty-five (25) pounds when necessary.

Benefits include but are not limited to:

• Health, Dental, and Vision insurance
• Life Insurance
• Short-term and Long-term Disability Insurance
• Paid Time Off and Paid Holidays
• 401k Retirement Plan
• Referral Program

Iowa Radiology, Professional Medical Management (PMM), and Iowa Diagnostic Imaging and Procedure Center (IDIPC), are equal opportunity employers. We are committed to fostering a diverse, inclusive, and respectful workplace. All qualified candidates are given equal employment opportunity without regard to race, color, national origin, sex, gender identity, sexual orientation, age, disability, religion, or any other characteristic protected by federal, state, or local law.

We celebrate diversity and are committed to creating an inclusive environment for all employees. Reasonable accommodations are available to individuals with disabilities from the application process and throughout employment with any of our companies.