Denials Management Specialist

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

• Paid Time Off from Day One

• 403-B Retirement Plan

• 4 Weeks 100% Paid Parental Leave

• Career Development

• Whole Person Well-being Resources

• Mental Health Resources and Support

• Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

2600 LUCIEN WAY

City:

MAITLAND

State:

Florida

Postal Code:

32751

Job Description:

Reviews and resolves accounts daily, focusing on complex denials across multiple payers and regions. Conducts account history research, including patient encounters, charge/payment histories, and payer remittance advice. Follows up on claims to review contract discrepancies and account balances, attaching documentation, amending data, gathering additional information, and resubmitting corrected claims. Reviews EOBs or contacts payers for denied claims status. Defends and appeals denied claims by researching root causes, collecting necessary information, adjusting accounts, resubmitting claims, and following up to ensure adjudication. Communicates denial root causes and resolutions to leadership. Aggregates data and sends complete appeal packets via mail, fax, or Federal Express using the denials management tool. Identifies system loading discrepancies and refers them for correction. Understands managed care payment methodologies and principles, interpreting multiple payment methodologies for various payer types, including Commercial Managed Care, Managed Medicare, Managed Medicaid, and other governmental payers. Identifies payer performance trends by analyzing data on claim approvals, denials, and payment timelines. Reviews denial management correspondence to understand reasons for claim denials and develops strategies to address them. Handles auditing bodies’ correspondence by providing necessary documentation and responses. Other duties as assigned.Knowledge, Skills, and Abilities:
• Basic understanding of an explanation of benefits (EOB) [Required]• Basic knowledge of CPT, ICD-10, and HCPCS coding standards [Required]• Strong organizational skills [Required]• Strong keyboard and 10 key skills [Required]• Proficiency in Microsoft Suite applications, specifically Excel and Word applications, as well as Outlook [Required]• Ability to communicate effectively in written and oral form with diverse populations [Required]• Interpersonal skills to promote teamwork throughout the Denials Management team [Required]• Ability to multitask and function in a fast-paced environment [Required]• Ability to prioritize and problem-solve [Required]• Self-motivated and able to work with multiple and multi-functional teams [Required]• Work within very tight time frames [Required]• Comfort with interpreting payer contractual language [Preferred]• Ability to navigate payer website/portals to perform remittance research and gather additional information needs [Preferred]• Experience in healthcare claims processing and proficiency with medical billing and remittance forms and processes, including 835 and 837 files, and UB04 and CMS-1500 (HCFA) forms [Preferred]• Technical proficiency within Patient Accounting systems and denial management workflow technology; position requires ability to navigate various modules within applicable technologies to perform account research [Preferred]

Education:
• High School Grad or Equiv [Required]

Field of Study:
• or equivalent
• Advanced degree in any field of study

Work Experience:
• 1+ experience in billing, a/r follow up and/or denials management & appeal writing [Required]

Additional Information:
• N/A

Licenses and Certifications:
• N/A

Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements – https://tinyurl.com/23km2677

Pay Range:

$19.76 – $36.75

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.