Insurance Denial Specialist
Recovery & Wellness Centers of Midwest Ohio, Greenville, Ohio, United States, 45331
Description
Values:
Employees of Darke County Recovery Services, DBA Recovery and Wellness Centers of Midwest Ohio are expected to value highest ethical standards, quality clinical care, and good customer service. We also value quality communication skills in a collaborative, multidisciplinary and often multi-agency service environment.
Responsibilities: Claims Review & Resolution
Examine denied or underpaid insurance claims to determine reasons for denial.
Research payer guidelines, coding requirements, and policy rules to determine appropriate next steps.
Correct claim errors, gather additional documentation, and resubmit or appeal claims as necessary.
Maintain accurate records of denial reasons, corrective actions, and resolution outcomes.
Appeals & Follow-Up
Prepare and submit timely appeals supported with medical records, coding justification, or policy clarification.
Communicate with insurance companies to dispute incorrect denials or request reconsideration.
Track open appeals and follow up until payment, partial approval, or final determination.
Collaboration & Communication
Coordinate with physicians, coders, billing staff, and administrative teams to resolve documentation issues.
Educate staff on common denial trends and recommend process improvements.
Communicate clearly with patients when additional information is needed.
Data & Reporting
Document denial categories and recovery metrics for management review.
Identify recurring denial patterns and work with leadership to reduce preventable denials.
Utilize billing software, electronic health records (EHR), and payer portals to complete daily tasks.
Preferred Qualifications
Certification in medical billing or coding (e.g., CPC, CPB, CCS, CMRS).
Prior experience in appeals management or denial prevention.
Knowledge of payer-specific rules (Blue Cross, United Healthcare, Aetna, etc.).
Competencies:
Teamwork
Judgment/Decision Making
Communication Skills
Trustworthiness & Ethics
Accountability
Communication, Verbal and Written
Problem solving
Organizational skills
Technology Skills
Client Service/Commitment to Service
Requirements: High school diploma/GED.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to stand, walk, sit, talk and hear.
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Responsibilities: Claims Review & Resolution
Examine denied or underpaid insurance claims to determine reasons for denial.
Research payer guidelines, coding requirements, and policy rules to determine appropriate next steps.
Correct claim errors, gather additional documentation, and resubmit or appeal claims as necessary.
Maintain accurate records of denial reasons, corrective actions, and resolution outcomes.
Appeals & Follow-Up
Prepare and submit timely appeals supported with medical records, coding justification, or policy clarification.
Communicate with insurance companies to dispute incorrect denials or request reconsideration.
Track open appeals and follow up until payment, partial approval, or final determination.
Collaboration & Communication
Coordinate with physicians, coders, billing staff, and administrative teams to resolve documentation issues.
Educate staff on common denial trends and recommend process improvements.
Communicate clearly with patients when additional information is needed.
Data & Reporting
Document denial categories and recovery metrics for management review.
Identify recurring denial patterns and work with leadership to reduce preventable denials.
Utilize billing software, electronic health records (EHR), and payer portals to complete daily tasks.
Preferred Qualifications
Certification in medical billing or coding (e.g., CPC, CPB, CCS, CMRS).
Prior experience in appeals management or denial prevention.
Knowledge of payer-specific rules (Blue Cross, United Healthcare, Aetna, etc.).
Competencies:
Teamwork
Judgment/Decision Making
Communication Skills
Trustworthiness & Ethics
Accountability
Communication, Verbal and Written
Problem solving
Organizational skills
Technology Skills
Client Service/Commitment to Service
Requirements: High school diploma/GED.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to stand, walk, sit, talk and hear.
#J-18808-Ljbffr