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Job Requirements of Sr. Denials Representative:
QUALIFICATIONS / EXPERIENCE:- Thorough knowledge of physician billing policies and procedures
- Computer literate, working knowledge of Excel
- Able to work in a fast-paced environment
- Good organizational and analytical skills.
- Good oral and written communication skills
- Ability to work independently
- Ability to lead assigned team.
- High school diploma or equivalent
- Minimum 3 years’ previous medical billing experience required with emphasis on research and claim denials
- General knowledge of ICD and CPT coding
SUPERVISORY RESPONSIBILITIES:
- Provides departmental leadership through example by performing in a lead capacity
- Assists Denials & Appeals Supervisor to ensure that representatives are performing assigned duties and adhering to billing center/departmental policies, procedures and Code of Conduct
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Sr. Denials Representative
TeamHealth
Louisville, TN (Remote)
Full-Time
JOB DESCRIPTION OVERVIEW:
The Sr. Denials Representative is responsible for monitoring workflow trends and communicating to the Denials & Appeals Supervisor and A/R Manager. The Appeals Senior is a resource for their assigned team as well as the Denials & Appeals Supervisor and A/R Manager. The Appeals Senior is responsible for compiling and preparing reports utilizing Enterprise Task Manager and the Informatics Reporting System when needed. The department’s goal is to examine and take action to support the provider’s interest in working denials and appealing to the insurance carriers when necessary.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
The Sr. Denials Representative is responsible for monitoring workflow trends and communicating to the Denials & Appeals Supervisor and A/R Manager. The Appeals Senior is a resource for their assigned team as well as the Denials & Appeals Supervisor and A/R Manager. The Appeals Senior is responsible for compiling and preparing reports utilizing Enterprise Task Manager and the Informatics Reporting System when needed. The department’s goal is to examine and take action to support the provider’s interest in working denials and appealing to the insurance carriers when necessary.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Review Rejection PIT (Point in Time) Report for Open and Pended invoices for problematic areas
- Review Rejection Outcome Report to Verify Invoices are worked properly through audit
- Assist assigned team as needed to reach Monthly Metrics and Goals
- For each assigned team member review work performed, prepare QA reports and communicate to each team member and management
- Responsible for training new employees and monitoring new employee production and QA. Reporting any concerns to the Denials & Appeals Supervisor/A/R Manager
- Provides departmental leadership through example by performing in a lead capacity including but not limited to adhering to work schedules; continuing significantly above average productivity and quality of assigned work
- Review carrier manuals and websites and informs management of any new procedures implemented by the carrier that are impacting claims
- Process Non-Routine Write-off adjustments as needed
- Ensures appeals and corrected invoices are being processed within schedule and according to the individual insurance company plans policy
- Communicate with the Denials & Appeals Supervisor and A/R Manager on the progress of projects and assignments and progress toward completion on a timely basis
- Assist with any special projects as directed by the Denials & Appeals Supervisor/A/R Manager
- Other duties as assigned by the Denials & Appeals Supervisor/A/R Manager
- Work and maintain ETM escalation view
Job Requirements:
QUALIFICATIONS / EXPERIENCE:
SUPERVISORY RESPONSIBILITIES:
- Thorough knowledge of physician billing policies and procedures
- Computer literate, working knowledge of Excel
- Able to work in a fast-paced environment
- Good organizational and analytical skills.
- Good oral and written communication skills
- Ability to work independently
- Ability to lead assigned team.
- High school diploma or equivalent
- Minimum 3 years’ previous medical billing experience required with emphasis on research and claim denials
- General knowledge of ICD and CPT coding
SUPERVISORY RESPONSIBILITIES:
- Provides departmental leadership through example by performing in a lead capacity
- Assists Denials & Appeals Supervisor to ensure that representatives are performing assigned duties and adhering to billing center/departmental policies, procedures and Code of Conduct
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