United States onlyJob Summary:
The Lead Follow Up and Denial Management Specialist will have a full understanding of the follow up and denial/appeal process. Will act as a liaison between the HB Follow Up and Denial Team, HIM coding staff and/or HIM Coding Manager, customer service staff, CBO financial analysts, Physician Advisor, pre-certification staff, care management staff and Epic CTs as needed. They will be responsible for working assigned workqueues including, but not limited to, denials, no response, outstanding insurance balance, and credit and. Lead specialist may be tasked with projects or issues where team members need assistance in resolving complicated or difficult situations encountered when working denials. The Lead Specialist will work and monitor high dollar claims to ensure payment and resolution. The Lead Specialist will be the main liaison to communicate with and assist Physician Advisor with appeals on all payors. This position will be responsible to assist in training of new team members. The lead must become familiar with payor policies, guidelines, proper appeal processes, and know how to research effectively. The position requires communication with provider payor representatives and holding them accountable when claim issues arise. This position will be a hybrid work model, with the majority of time spent working remotely.
Essential Job Duties:
- Responsible for assigned Epic workqueues.
- Liaison between HB Follow Up and Denial Team Members and other staff as needed
- Responsible for denial research, payer policy review, appeal processes and educating the staff on these findings.
- Responsible for training of new staff as a preceptor
- Communication with Provider Payor Representatives
- Communication with Physician Advisor
- Tasks/Projects assigned by the supervisor.
Secondary Job Duties That May be Reassigned:
- Performs other duties as assigned by the Revenue Cycle Director.
Job Specifications:
- Education: High School Diploma required.
- Certifications: Certified Patient Financial Services Specialist. Coding certification preferred but not required
