EHPB Denial Management Specialist
EvergreenHealth, Kirkland, Washington, United States, 98034
Overview
Wage Range: $21.09 - $33.75 per hour. Hybrid in Washington State only - Medical Billing.
Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.
Job Summary Investigates health plan denials to determine appropriate action and provide resolution.
Primary Duties
investigates insurance denials to identify action necessary.
Corrects claims based on denials, complaints and audits and rebills using payor approved process.
Determines need for payor appeal and sends individualized appeal letter. Monitors appeals for resolution
Adjustsdenials determined to be appropriate using the corresponding adjustment code(s).
Works the accounts that meet denial management criteria and coordinates resolution with other departments. Denial management criteria include accounts that have potential financial impact such as authorization and refer denials, bundling issues and medical necessity for all assigned payers.
Logs all denials including actions and resolution on Denial spreadsheet.
Identify denial pattern to identify potential process improvement.
Produces quarterly denial reports.
License, Certification, Education or Experience REQUIRED
for the position:
High School graduate or equivalent.
1-year previous experience in professional billing.
Knowledge and experience in working with health care insurers' and their reimbursement systems, especially Medicare, Medicaid, Workers Compensation, Motor Vehicle and contract payers.
A good understanding of CPT, Modifiers, HCPC, ICD-10 codes and medical terminologies.
Demonstrated problem solving ability.
Ten-key by touch
DESIRED
for the position:
College degree/Vocational training in billing or business
Benefit Information Choices that care for you and your family
At EvergreenHealth, we appreciate our employees’ commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.
Medical, vision and dental insurance
On-demand virtual health care
Health Savings Account
Flexible Spending Account
Life and disability insurance
Retirement plans (457(b) and 401(a) with employer contribution)
Tuition assistance for undergraduate and graduate degrees
Federal Public Service Loan Forgiveness program
Paid Time Off/Vacation
Extended Illness Bank/Sick Leave
Paid holidays
Voluntary hospital indemnity insurance
Voluntary identity theft protection
Voluntary legal insurance
Pay in lieu of benefits premium program
Free parking
Commuter benefits
View a summary of our total rewards available to you as an EvergreenHealth team member by noting the EvergreenHealth Benefits Guide.
#J-18808-Ljbffr
Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.
Job Summary Investigates health plan denials to determine appropriate action and provide resolution.
Primary Duties
investigates insurance denials to identify action necessary.
Corrects claims based on denials, complaints and audits and rebills using payor approved process.
Determines need for payor appeal and sends individualized appeal letter. Monitors appeals for resolution
Adjustsdenials determined to be appropriate using the corresponding adjustment code(s).
Works the accounts that meet denial management criteria and coordinates resolution with other departments. Denial management criteria include accounts that have potential financial impact such as authorization and refer denials, bundling issues and medical necessity for all assigned payers.
Logs all denials including actions and resolution on Denial spreadsheet.
Identify denial pattern to identify potential process improvement.
Produces quarterly denial reports.
License, Certification, Education or Experience REQUIRED
for the position:
High School graduate or equivalent.
1-year previous experience in professional billing.
Knowledge and experience in working with health care insurers' and their reimbursement systems, especially Medicare, Medicaid, Workers Compensation, Motor Vehicle and contract payers.
A good understanding of CPT, Modifiers, HCPC, ICD-10 codes and medical terminologies.
Demonstrated problem solving ability.
Ten-key by touch
DESIRED
for the position:
College degree/Vocational training in billing or business
Benefit Information Choices that care for you and your family
At EvergreenHealth, we appreciate our employees’ commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.
Medical, vision and dental insurance
On-demand virtual health care
Health Savings Account
Flexible Spending Account
Life and disability insurance
Retirement plans (457(b) and 401(a) with employer contribution)
Tuition assistance for undergraduate and graduate degrees
Federal Public Service Loan Forgiveness program
Paid Time Off/Vacation
Extended Illness Bank/Sick Leave
Paid holidays
Voluntary hospital indemnity insurance
Voluntary identity theft protection
Voluntary legal insurance
Pay in lieu of benefits premium program
Free parking
Commuter benefits
View a summary of our total rewards available to you as an EvergreenHealth team member by noting the EvergreenHealth Benefits Guide.
#J-18808-Ljbffr