Denials & Follow Up Specialist

Description

The Denials & Follow-Up Specialist is responsible for processing insurance follow up and denial claims in a timely manner. Performs outgoing calls to patients and insurance companies to obtain necessary information for accurate billing. Answers incoming calls from insurance companies requesting additional information and/or checking status of billings.

Duties/Responsibilities:

• Works with insurance companies to ensure proper reimbursement on patient accounts. Depending on payer contract may be required to participate in conference calls and prepare accounts receivable reports, compiles the issue report in order to expedite resolution of accounts. 
• Examines contract to ensure proper reimbursement, updates IT resources if system is not calculating payment accurately. 
• Works follow up report daily, maintaining established goal(s), and notifies manager of issues preventing achievement of such goal(s). Follows up on daily correspondence (denials, underpayments) to appropriately work patient accounts. Assists customer service with patient concerns/questions to ensure prompt and accurate resolution is achieved. Produces written correspondence to payors and patients regarding status of claim, requesting additional information, etc. 
• Reviews previous account documentation, determining appropriate action(s) necessary to resolve each assigned account. Initiates next billing, follow-up and/or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate. 
• Documents billing, follow-up and/or collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to manager if necessary. 
• Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account.

Requirements

Required Skills/Abilities:

• Knowledge of lab billing preferred but not required
• Focused and detail-oriented
• Ability to be responsive to ever-changing matrix of clinic/center needs and act accordingly. 
• Typing skills equal to 30 words per minute
• Proficiency in performance of basic math functions
• Ability to communicate professionally and effectively in English, both verbally and in writing
• Knowledge of Microsoft Office products such as Word and Excel

Education and Experience:

• At least one year of experience with medical insurance denials preferably in a laboratory setting.  

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.