Job Description

Job Title: AR Denial Management SpecialistOverview: As an Accounts Receivable (AR) Denial Management Specialist, you will play a critical role in ensuring the efficient and effective resolution of denied claims. You will be responsible for identifying, analysing, and appealing denied claims to maximize reimbursement for the organization. Your expertise in healthcare billing and coding, as well as your attention to detail, will be essential in reducing the organization\'s accounts receivable backlog and improving overall revenue cycle performance.Key Responsibilities:Pre-Call Analysis: Perform pre-call analysis and check status by calling the payer or using IVR or web portal servicesDenial Analysis: Review and analyse denied claims to determine the root cause of denials, including coding errors, missing information, and payer-specific requirements.Documentation: Maintain adequate documentation on the client software to send necessary documentation to insurance companies and maintain a clear audit trail for future referenceAppeals Management: Develop and execute appeal strategies to overturn denied claims, including preparing appeal letters, gathering supporting documentation, and following up with payers.Payer Communication: Maintain open communication channels with payers to resolve denial issues promptly and effectively, including phone calls, emails, and online portals.Documentation Review: Ensure that all necessary documentation, including medical records and billing records, is complete and accurate to support claim appeals.Process Improvement: Identify opportunities for process improvement in denial management workflows to streamline operations and reduce the frequency of denials.Collaboration: Collaborate with internal stakeholders, including billing staff, coding specialists, clinicians, and revenue cycle management teams, to resolve denial issues and optimize revenue cycle processes.Qualifications:Education: Bachelor\'s degree in healthcare administration, business administration, or related field preferred.Experience: Minimum of 2-3 years of experience in healthcare billing and reimbursement, with a focus on denial management and appeals. Experience with both commercial and government payers preferred.Knowledge: Thorough understanding of healthcare billing and coding practices, including CPT, ICD-10, and HCPCS coding systems. Familiarity with Medicare, Medicaid, and third-party payer guidelines.Skills:Strong analytical and problem-solving skills.Excellent communication skills, both written and verbal.Attention to detail and accuracy in documentation.Proficiency in Microsoft Office suite, particularly Excel and Word.Ability to prioritize tasks and manage time effectively in a fast-paced environment.Software Proficiency: Experience with healthcare billing and practice management software systems (e.g., Epic, Cerner, Meditech) and claims processing platforms.Team Player: Ability to work collaboratively in a team environment and build positive relationships with colleagues and external stakeholders.Adaptability: Willingness to adapt to changing regulations, payer requirements, and organizational priorities in the healthcare industry.Work Environment: The AR Denial Management Specialist will primarily work in an office setting within a healthcare organization.Powered by JazzHR

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