Jobs and Careers at the U.S. Medical Management Talent Network

Denial Management Specialist

Department: Billing
Location: Troy, MI
Company: USMM

Denial Management Specialist 

U.S. Medical Management (USMM), an affiliate of a leading Fortune 250 company, manages a nationwide continuum of premier providers of medical services delivered primarily to the homes of elderly and homebound patients. Providing primary home care is the future of medicine, and at USMM, the future is now. With the knowledge and experience to address the evolution of healthcare, USMM is poised for a phenomenal future.

POSITION DESCRIPTION  

This position is responsible for the optimal payment of claims from Medicare, Medicaid, BCBS, Commercial, and Manage Care Plans; primary duties include, but are not limited to, consistently follow up on unpaid/denied claims utilizing monthly aging reports, filing appeals when appropriate to obtain maximum reimbursement and establish and maintain strong relationships with Providers, clients and fellow staff, and monitor trend in denials of payment changes.

ESSENTIAL DUTIES AND RESPONSIBILITIES  

  • Review claims failed on front end edits due to various reasons; analyze the root cause by contacting patients/payers/inter-departments and Clearing House
  • Work with inter-department and other parties involved for lack of information that may be causing up front payer rejections; correct and submit clean claims
  • Review and analyze insurance claims with accounts receivable balances that have aged beyond 30 days old or claims denied in the Insurance Follow-Up Module and A/R reports
  • Access denied claims from the worklist and queries claim status with the payor, utilizing all appropriate systems, websites to effectively research the claim and resubmit or appeal as necessary
  • Make necessary arrangements for medical records requests, completion of additional information requests, etc. as requested by insurance companies to ensure timely resolution of outstanding denied/unpaid claims
  • Prioritizes claims based on aging and outstanding dollar amounts, or as directed by management
  • Regularly meet with Supervisor to discuss challenges or billing obstacles as well as to provide status of outstanding aging reports

REQUIRED KNOWLEDGE, SKILLS, AND EXPERIENCE  

  • High School Diploma or Equivalent
  • Minimum of 2 years insurance follow up experience in a healthcare insurance environment and ability to multi task
  • Computer experience is essential, including but not limited to: practice management software, word processing, and spreadsheet applications, and 10-key
  • Knowledge of multi-specialty Physician billing procedure guidelines according to Medicare, Medicaid, Commercial, and third party payer policies and basic understanding of medical terminology, ICD 9 and CPT 4
  • Experience in filing claim appeals with different payers to ensure maximum entitled reimbursement
  • Ability to perform mathematical computations
  • Skill in defining problems, collecting data, and interpreting billing information
  • Additionally, the ability to work effectively with staff, patients, public, and external agencies
  • Good customer service and telephone techniques required, as well as a high level of confidentiality

PREFERRED KNOWLEDGE, SKILLS, AND EXPERIENCE  

  • Certification in Medical Billing/Coding 
  • Two years of related experience
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