Processes accounts that meet coding denial management criteria which includes rejections, down codes, bundling issues, modifiers, level of service and other assigned ques
Resolve work queues according to the prescribed priority and/or per the direction of management in accordance with policies, procedures, and other job aides
Validate denial reasons and ensures coding is accurate
Generate an appeal based on the dispute reason and contract terms specific to the payor
Follow specific payer guidelines for appeals submission
Escalate exhausted appeal efforts for resolution
Adhere to departmental production and quality standards
Complete special projects as assigned by management
Maintain working knowledge of workflow, systems, and tools used in the department

High school diploma or equivalent
One to three years’ experience in physician medical billing with emphasis on research and claim denials
Current AAPC or AHIMA certification required
Knowledge of health insurance, including coding
Thorough knowledge of physician billing policies and procedures
Thorough knowledge of healthcare reimbursement guidelines
Knowledge of AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding
Computer literate, working knowledge of Excel helpful
Good organizational and analytical skills
Ability to work independently
Proficient computer skills, with the ability to learn applicable internal systems
Strong oral, written, and interpersonal communication skills
Strong time management and organizational skills

Denials Specialist

Key skills