About this role
Location:
Calmont Operations BuildingDepartment:
CBO/Patient Financial ServicesShift:
First Shift (United States of America)Standard Weekly Hours:
40Summary:
The denials specialist is responsible for appealing and resolving claim denials. Responsibilities include determining the root cause of the denial, appealing the denial, pursuing the payor for reconsideration, taking appropriate resolution steps, tracking recoveries, and successfully recovering denied amounts as efficiently as possible. Working under the direction of the Reimbursement Manager, the Denials Specialist assists in tracking and reporting payor denials and contract-related discrepancies. Denials are referred to the Denials Specialist via denials work queue based upon the reason code provided by the payor on the remittance.
Qualifications:
High School diploma or equivalent
2 years hospital or physician revenue cycle or contracting experience required or 2 years experience working for a health plan in a capacity that pays claims, handles appeals and/or reviews contract terms
Ability to understand contract terms and calculate reimbursement
Knowledge of the payor appeal timeframes, levels and operations in order to successfully maneuver payor operations
Excellent written and oral communication skills to effectively appeal denials and communicate with payors and other departments
Knowledge of healthcare related financial and/or accounting practices
Ability to manipulate data using excel
Ability to deal effectively with constant changes and be a change agent
Detailed knowledge of health plan operations, reimbursement methodologies, payer contracts and clinical policies
Knowledge of state, federal and compliance regulations as they pertain to coding and billing processes and procedures
Prior experience with Epic Systems Revenue Cycle Solutions preferred
About Us:
Cook Children's Medical Center is the cornerstone of Cook Children's, and offers advanced technologies, research and treatments, surgery, rehabilitation and ancillary services all designed to meet children's needs.
Cook Children's is an EOE/AA, Minority/Female/Disability/Veteran employer.
Other facts
About Cook Children's Health Care System
Cook Children's Health Care System embraces an inspiring Promise – to improve the health of every child in our region through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community.
What you'll do
- The Denials Specialist is responsible for appealing and resolving claim denials, determining the root cause, and pursuing payor reconsideration. They also track recoveries and report on payor denials and discrepancies.
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