Denial Management Specialist Lead, Region A

Company: HarmonyCares
Location: Troy
Posted on: March 21, 2023

Job Description:

Denial Management Specialist Lead, Region AHarmonyCares is one of the nation's largest home-based primary care practices. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home. This includes HarmonyCares, HarmonyCares Medical Group, HarmonyCares Home Health, HarmonyCares Hospice and The Home DME.Our Mission - "Through Compassionate Patient-Centered Care in the Home; We will Provide Exceptional Outcomes across our Continuum of Services"Our Values - Respect, Integrity, Teamwork and Excellence - are leading us to a better tomorrow for patient care. Why You Should Want to Work with Us

• Health, Dental, Vision, Disability & Life Insurance, and much more
• 401K Retirement Plan (with company match)
• Tuition, Professional License and Certification Reimbursement
• Paid Time Off, Holidays and Volunteer Time
• Paid Orientation and Training
• Day Time Hours (no holidays/weekends)
• Great Place to Work Certified
• Established in 11 states
• Largest home-based primary care practice in the US for over 28 years, making a huge impact in healthcare today!Position DescriptionThe Denial Management Specialist Lead, Region A is responsible for the optimal payment of claims from Medicare, Medicaid, BCBS, Commercial and Manage Care Plans for region A in assigned states. This position will consistently follow up unpaid/denied claims utilizing monthly aging reports, file appeals when appropriate to obtain maximum reimbursement, establish and maintain strong relationships with providers, clients and fellow staff, and monitor trend in denials of payment changes. This position will be responsible for leading the team to resolve problems, as well as working with other departments on reimbursement challenges.
  • Assists with training and onboarding for new hires and cross training/specialized project training for current team members
  • Assists in creation/maintenance of Standard Operating Procedures
  • Acts as point of contact for issue resolution with the department
  • Participates in Rapid Improvement Events (RIEs) as needed
  • Assists with compiling and reviewing performance and quality metrics
  • Reviews claims failed on front end edits due to various reasons; analyzes the root cause by contacting patients/ payers / internal departments and clearing house
  • Reviews and analyzes 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
  • Assesses 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
  • Makes 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
  • Resolves for root cause denial reasons, reduces denial trends and communicates trends to management
  • Maintains personal contribution to productivity and quality metrics and standards of the department
  • Prioritizes claims based on aging and outstanding dollar amounts, or as directed by management
  • Regularly meets with supervisor to discuss challenges or billing obstacles as well as to provide status of outstanding ageing reports worked
  • Other duties as assignedRequired Knowledge, Skills and Experience
    • High School Diploma or GED
    • 5+ years of experience in insurance follow up and appeal claim submission in a healthcare insurance environment
    • Computer experience is essential, including but not limited to: practice management software, word processing and spreadsheet applications, and 10-key by touch
    • 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 and CPT codes
    • Good customer service and telephone techniques, as well as a high level of confidentiality Preferred Knowledge, Skills and Experience
      • Associate Degree
      • Certification in Medical Billing/Coding
      • Certified Revenue Cycle Representative (CRCR)Won't you join us? We are seeking candidates who desire the opportunity and experience of delivering quality and compassionate healthcare - within proven care models - to elderly individuals and those with complex medical issues, who are the forefront of everything we do.

Keywords: HarmonyCares, Troy , Denial Management Specialist Lead, Region A, Executive , Troy, Michigan