Denial Recovery Specialist
Wolcott, Wood and Taylor Inc., Chicago, IL, United States
Key Responsibilities
Denial Resolution & Appeals
Review denied professional claims to determine root cause and appropriate resolution.
Research payer policies, contracts, and billing guidelines to support appeals.
Prepare and submit timely, well-documented appeals and reconsiderations.
Follow up with payers to ensure proper adjudication and payment.
Track appeal outcomes and identify trends in overturn rates.
Accounts Receivable Management
Manage assigned A/R workqueues to ensure timely follow-up.
Prioritize high-dollar and aging claims to optimize cash flow.
Monitor denial aging and elevate unresolved issues appropriately.
Root Cause Analysis & Prevention
Identify trends in denials by payer, provider, specialty, CPT, or diagnosis and elevate to management.
Collaborate with coding and billing teams to address documentation or submission errors.
Provide feedback to front-end and coding teams to prevent recurring denials.
Assist in developing process improvements to improve clean claim rates.
Compliance & Accuracy
Ensure all billing and appeal activities comply with CMS, Medicare, Medicaid, and commercial payer regulations.
Maintain accurate documentation of actions taken on accounts.
Protect patient confidentiality in accordance with HIPAA guidelines.
Reporting & Performance Monitoring
Track and maintain user’s own productivity and quality metrics.
Participate in team meetings and training initiatives.
Qualifications Education
High school diploma required.
Associate or Bachelor’s degree in Healthcare Administration, Business, or related field preferred.
Experience
3–5 years of professional medical billing or denial management experience.
Strong knowledge of CPT, ICD-10, HCPCS billing or coding fundamentals.
Experience working with Medicare, Medicaid, and commercial payers.
Familiarity with Epic EHR system.
Core Competencies
Analytical and problem-solving skills.
Knowledge of payer guidelines and reimbursement methodologies.
Detail-oriented with strong documentation skills.
Effective written and verbal communication.
Ability to manage productivity goals and meet deadlines.
Team-oriented with a proactive approach.
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Review denied professional claims to determine root cause and appropriate resolution.
Research payer policies, contracts, and billing guidelines to support appeals.
Prepare and submit timely, well-documented appeals and reconsiderations.
Follow up with payers to ensure proper adjudication and payment.
Track appeal outcomes and identify trends in overturn rates.
Accounts Receivable Management
Manage assigned A/R workqueues to ensure timely follow-up.
Prioritize high-dollar and aging claims to optimize cash flow.
Monitor denial aging and elevate unresolved issues appropriately.
Root Cause Analysis & Prevention
Identify trends in denials by payer, provider, specialty, CPT, or diagnosis and elevate to management.
Collaborate with coding and billing teams to address documentation or submission errors.
Provide feedback to front-end and coding teams to prevent recurring denials.
Assist in developing process improvements to improve clean claim rates.
Compliance & Accuracy
Ensure all billing and appeal activities comply with CMS, Medicare, Medicaid, and commercial payer regulations.
Maintain accurate documentation of actions taken on accounts.
Protect patient confidentiality in accordance with HIPAA guidelines.
Reporting & Performance Monitoring
Track and maintain user’s own productivity and quality metrics.
Participate in team meetings and training initiatives.
Qualifications Education
High school diploma required.
Associate or Bachelor’s degree in Healthcare Administration, Business, or related field preferred.
Experience
3–5 years of professional medical billing or denial management experience.
Strong knowledge of CPT, ICD-10, HCPCS billing or coding fundamentals.
Experience working with Medicare, Medicaid, and commercial payers.
Familiarity with Epic EHR system.
Core Competencies
Analytical and problem-solving skills.
Knowledge of payer guidelines and reimbursement methodologies.
Detail-oriented with strong documentation skills.
Effective written and verbal communication.
Ability to manage productivity goals and meet deadlines.
Team-oriented with a proactive approach.
#J-18808-Ljbffr