[Hiring] Rejection and Denial Specialist @North American Partners in Anesthesia

Role Description

The Rejections and Denials Specialist will be responsible to work the denied eligibility claims for all assigned payers and states. This will include:

• Working within multiple work queues
• Contacting payers online or by phone
• Updating accounts as needed
• Identifying carrier-related denial trends

This position will need to maintain a thorough knowledge and understanding of:

• All charge corrections and FSC transfers
• Differences in charge corrections
• Familiarity with anesthesia modifiers, procedure codes, and diagnostic codes

In addition, there may be projects that may require a manual process by reviewing and working off spreadsheets.

PRIMARY RESPONSIBILITIES:

• Analyzes patient insurance to identify the correct insurance plan(s) by reviewing the plan selection and any necessary documents or payor portals.
• Accurately documents all the proper steps to ensure accounts are worked correctly in a timely manner.
• Has the ability to troubleshoot and resolve issues before they occur by collecting all the appropriate information to create useful error output.
• Identifies billing errors and charge correction errors through research to resolve claim errors in a timely manner for the more complex eligibility tasks.
• This could include contacting payers, referring office/hospital, or patients to obtain medical insurance information.
• Follows department directions, TIP sheets, procedure manuals, and departmental policy and procedures.
• Evaluates insurance payor set up with the billing system to confirm the eligibility payor connection logic.
• Assists management in optimizing the efficiency and quality of the eligibility team.
• Assists with training and educating new and established staff members.

Qualifications

• High school diploma or equivalent certification required
• 3 plus years of experience with eligibility related knowledge
• Knowledge of understanding guidelines for Medicare/Medicaid, government plans, HMOs, and PPOs
• At least one year of exceptional customer service skills
• 3 plus years of denials management experience
• Strong computer skills (including MS Word and Excel)
• Ability to think critically and resolve accounts with minimal supervision
• Strong working knowledge of billing procedures, insurance reimbursement, and guidelines preferably in a medical or anesthesia setting
• Ability to multitask, work in a team as well as independently
• Must be able to communicate effectively and professionally to patients, insurance companies along with co-workers and management
• Strong oral and written communication skills preferred
• Ability to perform at a high level of productivity and quality
• Work in collaboration with Team Lead to improve processes
• Ability to ensure confidentiality of sensitive information and maintain HIPAA compliance
• Exceptional organization and time management skills
• Must have professional and effective oral communications with co-workers, insurance representatives, clients, and patients

Benefits

• Salary: $19-22 hourly
• Generous benefits package, including:
• Paid Time Off
• Health, life, vision, dental, disability, and AD&D insurance
• Flexible Spending Accounts/Health Savings Accounts
• 401(k)
• Leadership and professional development opportunities

EEO Statement

North American Partners in Anesthesia is an equal opportunity employer.