Revenue Cycle Denials Specialist

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 a denials work queue based upon the reason code provided by the payor on the remittance.

Education & Experience

• 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.
• 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.
• Knowledge of the payor appeal timeframes, levels and operations in order to successfully maneuver payor operations.
• Ability to manipulate data using excel.
• Ability to understand contract terms and calculate reimbursement.
• High School diploma or equivalent.
• Prior experience with Epic Systems Revenue Cycle Solutions preferred
• Excellent written and oral communication skills to effectively appeal denials and communicate with payors and other departments.
• Ability to deal effectively with constant changes and be a change agent.
• Knowledge of healthcare related financial and/or accounting practices

Cook Children's is an EOE/AA, Minority/Female/Disability/Veteran employer.

Location: Cook Children's Health Care System · PN CBO/Pt Fin Svcs
Schedule: Full-Time, Days