Job description

Claims Denial/Appeal Specialist

Reports directly to Revenue Cycle Manager
POSITION QUALIFICATIONS:
A. Advanced working knowledge of billing operations, denial management and appeals, coding, payment, insurance claims submission.

B. Knowledge of CPT and ICD-10-CM coding

C. Working knowledge of methods, procedures, regulations and guidelines in patient billing

D. Current knowledge of insurance payer coding and reimbursement guidelines

E. Working knowledge and experience coordinating specific medical practice operations with billing and EHR system functions.

F. Proficient organizational skills, attention to detail and accuracy

G. Demonstrated ability to establish and maintain effective working relationships with internal and external parties

H. Ability to create strategies, develop work plans, prioritize efforts, and manage processes to achieve a high level result within the revenue cycle

I. Ability to exercise initiative, critical thinking, problem solving, and decision making

J. Excellent interpersonal and communication skills

K. Demonstrate customer service oriented attitude/behavior

ESSENTIAL POSITION RESPONSIBILITIES:

A. Utilizes billing system claims denial management tool efficiently and effectively

B. Works with Revenue Cycle Manager regarding denials and appeals from insurance payers due to coding or other issues

C. Communicates and educates providers and other staff on coding and documentation guidelines, rules, regulations, and changes

D. Works with Revenue Cycle Manager regarding denials and appeals from insurance payers due to coding or other issues

E. Utilizes individual payer provider portals for billing and claims management effectively

F. Knowledgeable of individual payer billing and denial operations manual processes maintained online by payers

G. Identify problems and provide feedback to Front Office Supervisor/Office Coordinator relating to Front Office staff errors or mistakes

H. Work with Revenue Cycle Manager to determine payer contract terms are followed correctly when claims are adjudicated

I. Works on special projects with payers regarding problems or mistakes made that require large scale corrections

J. Performs other tasks as assigned

Job Type: Full-time

Pay: $19.00 - $20.00 per hour

Benefits:

• 401(k)
• Health insurance
• Life insurance
• Paid time off

Physical setting:

• Office

Schedule:

• 8 hour shift

Ability to commute/relocate:

• Flagstaff, AZ 86001: Reliably commute or planning to relocate before starting work (Required)

Education:

• High school or equivalent (Preferred)

Work Location: In person

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