Denial Management Specialist
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AI Summary
The specialist is responsible for identifying, appealing, resolving, and reporting all third-party payer claim denials using tracking software, ensuring timely submission of written appeals to prevent financial penalties. They must also analyze denial activity to identify trends and root causes, generating regular reports on financial impact and appeal success rates.
Wage Range: $28.83 - $46.14 per hour
Healthcare medical billing and reimbursement
Remote in Washington State only
Remote in Washington State only
Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.
Job Summary:
Job Summary:
Responsible for the identification, appeal, resolution and reporting of all third-party payer claim denials at EvergreenHealth. Must have the ability to communicate and coordinate effectively with all levels of the institution and payer representatives. Responsible for analyzing denial activity to identify trends and denial sources and assists with the development of reports needed to investigate denial issues. Prepares, compiles, distributes and analyzes regular reports of denials and the financial impact.
Primary Duties:
Primary Duties:
1. Identifies and captures claims denials from third-party payers in denial tracking software and/or alternative denial tracking tools on a daily basis and updates throughout the appeal process as activities and responses occur.
2. Responsible for the submission of written letters of appeal to third-party payers within allotted timeframes to prevent financial penalties.
3. Works with Case Management, Health Information Management and Patient Financial Services to gather supporting documentation to strengthen the appeals process.
4. Maintains contact with payers about disputed claims and updates system documentation of ongoing efforts for each claim.
5. Generates reports of denial activity including but not limited to analysis of trends, financial impact, success rate of appeals and root causes. Submits reports to the Director of Revenue Integrity on a monthly basis and as needed.
6. Monitors private payer resources and websites to identify changes in payer requirements and incorporates into denial management processes. Distributes relevant updates to other departments (e.g. Patient Access, PFS, etc.) as necessary.
7. Performs other duties as assigned.
License, Certification, Education or Experience:
REQUIRED for the position:
● Associate's degree in related area or equivalent combination of education and experience
● 3 years of experience in a hospital or insurance industry setting
● High degree of knowledge regarding health care services reimbursement methodologies
● Knowledge of claim forms and remittance advices including coding and billing practices
● Experience in healthcare billing and reimbursement
● Ability to interpret contract language
● Working knowledge of medical terminology
DESIRED for the position:
● Bachelor's degree
● Proficiency in Cerner and Meditech systems
Benefit Information:
Choices that care for you and your family
Choices that care for you and your family
At EvergreenHealth, we appreciate our employees’ commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.
- Medical, vision and dental insurance
- On-demand virtual health care
- Health Savings Account
- Flexible Spending Account
- Life and disability insurance
- Retirement plans (457(b) and 401(a) with employer contribution)
- Tuition assistance for undergraduate and graduate degrees
- Federal Public Service Loan Forgiveness program
- Paid Time Off/Vacation
- Extended Illness Bank/Sick Leave
- Paid holidays
- Voluntary hospital indemnity insurance
- Voluntary identity theft protection
- Voluntary legal insurance
- Pay in lieu of benefits premium program
- Free parking
- Commuter benefits
View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.
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