Denials Resolution Representative

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Job Snapshot

• Employee Type: Full-Time
• Location: Akron, OH
• Job Type: Admin - Clerical Health Care Insurance
• Experience: Not Specified
• Date Posted: 13/1/2024

TeamHealth has ranked three years running as “The World's Most Admired Companies” by Fortune Magazine and one of America's 100 Most Trustworthy Companies by Forbes Magazine in past years. TeamHealth, an established healthcare organization is physician-led and patient-focused. We continue to grow across the U.S. from our Clinicians to our Corporate Employees and we want you to join us.

Benefits of working at TeamHealth:

• Career Growth Opportunities
• Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
• 401K program (Discretionary matching funds available)
• Employee Assistance Program
• Referral Program
• Dental plans & Vision plans
• GENEROUS Personal time off
• Eight Paid Holidays per year
• Quarterly incentive plans
• Training Programs
• Wellness programs
• Flexible work schedule

THIS IS A WORK-FROM-HOME POSITION- EQUIPMENT IS PROVIDED!

WE OFFER A FLEXIBLE WORK SCHEDULE!

This position starts at $17/hr and up depending on experience. Quarterly Incentives available after training is complete!

OVERVIEW:

The Denials Resolution Representative will review, organize, and monitor incoming payment denials, taking appropriate corrective action as directed by the Denials Resolution Supervisor and the A/R Manager. The Analyst responds to carrier issues as needed and processes all appeals including Medicare, Medicaid, Blue Shield, and Commercial carriers.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Monitor and review all payment denials as assigned in Enterprise Task Manager and process these claims in the time frame assigned within the system.
• Utilize the telephone and various carrier websites as research tools to expedite resolution for issues.
• Assembles and forwards documentation to appeal disputed claims through Waystar, if applicable.
• Assist with research and development of appropriate denial procedures.
• Contacts carriers to inquire on claims that have been denied and appealed.
• Assembles and forwards appropriate documentation to the Senior Analyst for provider related issues.
• Review carrier manuals and websites and informs management of any new procedures implemented by the carrier that are impacting our claims.
• Reports any consistent errors found during claims review that may affect claims from being processed correctly.
• Consistently meet established completion times for projects and assignments.
• Consistently meet and maintain the QA (95% or better) and designated production standards per sub-team.
• Performs additional duties as directed by the Denials Resolution Senior/Supervisor or the A/R Manager.

Job Requirements

QUALIFICATIONS / EXPERIENCE:

• Thorough knowledge of physician billing policies and procedures.
• Thorough knowledge of healthcare reimbursement guidelines.
• Computer literate, working knowledge of Excel helpful.
• Able to work in a fast-paced environment.
• Good organizational and analytical skill.
• Ability to work independently.
• High school diploma or equivalent.
• One to three years' experience in physician medical billing with emphasis on research and claim denials.
• General knowledge of ICD and CPT coding.

SUPERVISORY RESPONSIBILITIES:

• None