EHPB Denial Management Spec
EvergreenHealth
About the role
Job Summary:
Investigates health plan denials to determine appropriate action and provide resolution.
Primary Duties:
- Investigates insurance denials to identify action necessary.
- Corrects claims based on denials, complaints and audits and rebills using payor approved process.
- Determines need for payor appeal and sends individualized appeal letter. Monitors appeals for resolution.
- Adjusts denials determined to be appropriate using the corresponding adjustment code(s).
- Works the accounts that meet denial management criteria and coordinates resolution with other departments. Denial management criteria include accounts that have potential financial impact such as authorization and refer denials, bundling issues and medical necessity for all assigned payers.
- Logs all denials including actions and resolution on Denial spreadsheet.
- Identify denial pattern to identify potential process improvement.
- Produces quarterly denial reports.
License, Certification, Education or Experience:
Required for the position:
- High School graduate or equivalent.
- 1-year previous experience in professional billing.
- Knowledge and experience in working with health care insurers and their reimbursement systems, especially Medicare, Medicaid, Workers Compensation, Motor Vehicle and contract payers.
- A good understanding of CPT, Modifiers, HCPC, ICD-10 codes and medical terminologies.
- Demonstrated problem solving ability.
- Ten-key by touch.
Desired for the position:
- College degree/Vocational training in billing or business.
Benefit Information:
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
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