Accounts Specialist, Complex Denials Specialist

  • Monitor claims for missing information, authorization and control numbers(ICN//DCN)  
  • Research EOBs for payments or adjustments to resolve claim 
  • Contacts payers via phone or written correspondence to secure payment of claims; reconsideration and appeal submission.  
  • Access client systems for payment, patient, claim and data info 
  • Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems 
  • Secure needed medical documentation required or requested by third party insurance carriers  
  • Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure 
  • Perform other related duties as required 

Minimum Requirements & Competencies

  • 2-3 years of medical collections, denials and appeals experience 
  • Experience with all but not limited to the following denials- DRG downgrades, level of care, coding, medical necessity
  • Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI 
  • Intermediate knowledge of third party billing guidelines 
  • Intermediate knowledge of billing claim forms(UB04/1500) 
  • Intermediate knowledge of payor contracts- commercial and government