Role Description
The Medical AR Follow-up & Denial Specialist is primarily responsible for analyzing and resolving all insurance claim denials for DME Supplies. The individual in this position will:
• Generate effective written appeals to carriers using well-researched logic to recoup reimbursement on incorrectly denied claims.
• Appeal carrier denials through coding review, contract review, medical record review, and carrier interaction.
• Utilize a multitude of resources to ensure correct appeal processes are followed and completed in a timely manner.
• Demonstrate a high level of expertise in the management of denied claims and deploy an analytical approach to resolving denials.
• Recognize trends and patterns to proactively resolve recurring issues.
• Communicate identified denial patterns to management.
• Prioritize and process denials while maintaining high quality of work.
• Serve as an escalation point for unresolved denial issues.
• Inform team members of payer policy changes.
• Assist in educating employees when needed.
• Collaborate on special projects as needed.
• Assist manager with additional tasks as needed.
Essential Responsibilities and Tasks:
• Review denied claims to ensure coding was appropriate and make corrections as needed.
• Ensure billing and coding are correct prior to sending appeals or reconsiderations to payers.
• Investigate claims with no payer response to ensure claim was received by payer.
• Maintain a strong understanding of payer websites and appeal processes for all payers, including commercial and government payers.
• Review and identify trends or patterns of denials to prevent errors.
• Assist and confer with coder and billing manager concerning any coding problems.
• Exhibit strong research and analytical skills; must be a critical thinker.
• Stay current with compliance and changing regulatory guidelines.
• Demonstrate knowledge of coding and medical terminology to assess claim denials and determine if appeals are warranted.
• Support and participate in process and quality improvement initiatives.
• Achieve goals set forth by supervisor regarding error-free work, transactions, processes, and compliance requirements.
Qualifications
• Three or more years of DME billing/coding experience is required.
• Collections of insurance claims experience.
• Medicare and/or Medicaid background.
• Durable Medical Equipment (DME) experience.
• EDI transmission experience preferred.
• High school diploma or GED diploma.
Requirements
• Equipment is not provided; you must have your own computer.
Position Type
• This is a full-time 40 hour work week.
• Monday - Friday day shift.
• Occasional evening and weekend work may be required as job duties demand.
Other Duties
All other duties as assigned by management. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are requested of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
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