Physician/Hospital Denials Recovery Specialist

Position Highlights

Responsible for the coordination and management of timely insurance claim follow-up including identifying, monitoring, appealing, and resolving denied claims. Perform detailed analysis on denied claims with a focus on maximizing revenue

The Ideal Candidate

• In depth knowledge of Medicare and Medicaid regulations, third party reimbursement guidelines.
• Computer literate, knowledge of financial data analysis, intermediate Excel skills.
• Preferred – Physician claims experience in a multi-specialty environment, preferably with oncology and/or surgical experience.
  
  

Responsibilities

• Follow-up electronically and/or telephonically with payors for claim and appeal status.
• Make a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted.
• Research and prepare responses for payor requests for additional information and documentation.
• Review of non-clinical denials including identification of root cause.
• Resolve non-clinical denials which include researching and reviewing payor guidelines, writing and submitting appeals with supporting documentation if required.
• Other duties as assigned.
  
  

Credentials And Qualifications

• Associate degree required.
• A minimum of three (3) years’ experience working with medical claims in a hospital, physician, payor or third-party medical billing service setting with collection experience.
• * "in lieu of" Associate's, a H.S. Diploma with two (2) years of additional related claims/collection experience (total of 5) may be considered.

Position Highlights

Responsible for the coordination and management of timely insurance claim follow-up including identifying, monitoring, appealing, and resolving denied claims. Perform detailed analysis on denied claims with a focus on maximizing revenue

The Ideal Candidate

• In depth knowledge of Medicare and Medicaid regulations, third party reimbursement guidelines.
• Computer literate, knowledge of financial data analysis, intermediate Excel skills.
• Preferred – Physician claims experience in a multi-specialty environment, preferably with oncology and/or surgical experience.
  
  

Responsibilities

• Follow-up electronically and/or telephonically with payors for claim and appeal status.
• Make a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted.
• Research and prepare responses for payor requests for additional information and documentation.
• Review of non-clinical denials including identification of root cause.
• Resolve non-clinical denials which include researching and reviewing payor guidelines, writing and submitting appeals with supporting documentation if required.
• Other duties as assigned.
  
  

Credentials And Qualifications

• Associate degree required.
• A minimum of three (3) years’ experience working with medical claims in a hospital, physician, payor or third-party medical billing service setting with collection experience.
• * "in lieu of" Associate's, a H.S. Diploma with two (2) years of additional related claims/collection experience (total of 5) may be considered.