EvergreenHealth
Denial Management Specialist (Medical Billing)
EvergreenHealth, Kirkland, Washington, United States, 98034
Wage Range: $21.09 - $33.75 per hour
Hybrid in Washington State only - Medical Billing Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity. u00A0
Job Summary
: Investigates health plan denials to determine appropriate action and provide resolution. u00A0
Primary Duties
: 1. investigates insurance denials to identify action necessary. 2. Corrects claims based on denials, complaints and audits and rebills using payor approved process. 3. Determines need for payor appeal and sends individualized appeal letter.u00A0 Monitors appeals for resolution 4.. Adjustsu00A0denials determined to be appropriate using the corresponding adjustment code(s). 5. Works the accounts that meet denial management criteria and coordinates resolution with other departments.u00A0 Denial management criteria include accounts that have potential financial impact such as authorization and refer denials, bundling issues and medical necessity for all assigned payers. 6. Logs all denials including actions and resolution on Denial spreadsheet. 7. Identify denial pattern to identify potential process improvement. 8. Produces quarterly denial reports.
License, Certification, Education or Experience
:
REQUIRED u00A0for the position: u2022 High School graduate or equivalent. u2022 1-year previous experience in professional billing. u2022 Knowledge and experience in working with health care insurers' and their reimbursement systems, especially Medicare, Medicaid, Workers Compensation, Motor Vehicle and contract payers. u2022 A good understanding of CPT, Modifiers, HCPC, ICD-10 codes and medical terminologies. u2022 Demonstrated problem solving ability. u2022 Ten-key by touch
DESIRED u00A0for the position: u2022 College degree/Vocational training in billing or businessu00A0 u00A0
Benefit Information: Choices that care for you and your family u00A0
u00A0 At EvergreenHealth, we appreciate our employeesu2019 commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.u00A0 u00A0
Medical, vision and dental insurance u00A0 On-demand virtual health care u00A0 Health Savings Account u00A0 Flexible Spending Account u00A0 Life and disability insurance u00A0 Retirement plans (457(b) and 401(a) with employer contribution) u00A0 Tuition assistance for undergraduate and graduate degrees u00A0 Federal Public Service Loan Forgiveness program u00A0 Paid Time Off/Vacation u00A0 Extended Illness Bank/Sick Leave u00A0 Paid holidays u00A0 Voluntary hospital indemnity insurance u00A0 Voluntary identity theft protection u00A0 Voluntary legal insurance u00A0 Pay in lieu of benefits premium program u00A0 Free parking u00A0 Commuter benefitsu00A0 u00A0 View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below. u00A0 EvergreenHealth Benefits Guide u00A0 #J-18808-Ljbffr
Hybrid in Washington State only - Medical Billing Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity. u00A0
Job Summary
: Investigates health plan denials to determine appropriate action and provide resolution. u00A0
Primary Duties
: 1. investigates insurance denials to identify action necessary. 2. Corrects claims based on denials, complaints and audits and rebills using payor approved process. 3. Determines need for payor appeal and sends individualized appeal letter.u00A0 Monitors appeals for resolution 4.. Adjustsu00A0denials determined to be appropriate using the corresponding adjustment code(s). 5. Works the accounts that meet denial management criteria and coordinates resolution with other departments.u00A0 Denial management criteria include accounts that have potential financial impact such as authorization and refer denials, bundling issues and medical necessity for all assigned payers. 6. Logs all denials including actions and resolution on Denial spreadsheet. 7. Identify denial pattern to identify potential process improvement. 8. Produces quarterly denial reports.
License, Certification, Education or Experience
:
REQUIRED u00A0for the position: u2022 High School graduate or equivalent. u2022 1-year previous experience in professional billing. u2022 Knowledge and experience in working with health care insurers' and their reimbursement systems, especially Medicare, Medicaid, Workers Compensation, Motor Vehicle and contract payers. u2022 A good understanding of CPT, Modifiers, HCPC, ICD-10 codes and medical terminologies. u2022 Demonstrated problem solving ability. u2022 Ten-key by touch
DESIRED u00A0for the position: u2022 College degree/Vocational training in billing or businessu00A0 u00A0
Benefit Information: Choices that care for you and your family u00A0
u00A0 At EvergreenHealth, we appreciate our employeesu2019 commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.u00A0 u00A0
Medical, vision and dental insurance u00A0 On-demand virtual health care u00A0 Health Savings Account u00A0 Flexible Spending Account u00A0 Life and disability insurance u00A0 Retirement plans (457(b) and 401(a) with employer contribution) u00A0 Tuition assistance for undergraduate and graduate degrees u00A0 Federal Public Service Loan Forgiveness program u00A0 Paid Time Off/Vacation u00A0 Extended Illness Bank/Sick Leave u00A0 Paid holidays u00A0 Voluntary hospital indemnity insurance u00A0 Voluntary identity theft protection u00A0 Voluntary legal insurance u00A0 Pay in lieu of benefits premium program u00A0 Free parking u00A0 Commuter benefitsu00A0 u00A0 View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below. u00A0 EvergreenHealth Benefits Guide u00A0 #J-18808-Ljbffr