Denial Management Specialist

Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.

OCCUPATIONAL SUMMARY

Files written letters of appeal on claims denied by the insurance carriers. Performs extensive telephone contact with the insurance companies to conclude payment on the denied claims. Utilizes Northside’s contract summaries to verify balances due on disputed claims. 

PRIMARY DUTIES AND RESPONSIBILITIES

1. Drafts written letters of appeal on various types of denied claims utilizing standard letters as well as customized letters depending on the denial.
2. Utilizes/reviews account information from various sources; on line data, hard copy reports, referral forms, UB92/itemized bills and EOBs to discuss account condition with the payer.
3. Obtains information from Northside’s contract summaries to negotiate reimbursement requirements of a claim.
4. Refers accounts to appropriate departments for necessary action to be taken i.e., balance transfers, electronic billing of accounts, audit and coding reviews, etc.
5. Contacts insurance companies to follow up on appealed claims. Holds insurance company accountable for timely resolution of all appeals submitted.
6. Maintains appropriate and accurate system documentation with notes and standard note codes allowing for appropriate extraction of denial data from the Denial database.
7. Notifies Supervisor of payor trends in denied accounts.

KNOWLEDGE SKILLS AND ABILITIES/LICENSE OR CERTIFICATION REQUIRED

1. B.S. degree, or equivalent college courses, in Health Science, Bookkeeping or Business, plus 3 years insurance collections/ AR receivables experience OR Associate’s degree, plus 4 years experience in healthcare receivables or related field OR 5 years experience in healthcare receivables or related field
2. Knowledge of healthcare receivables and collections, including denial and appeal processes.
3. Good verbal and written communication skills.
4. Proficient calculator experience.

KNOWLEDGE SKILLS AND ABILITIES/LICENSE OR CERTIFICATION PREFERRED

1. CPAR certification.
2. Knowledge and experience with Excel.
3. Experience with STAR, McKesson products.