Claims Denial Specialist
Job Posting for Claims Denial Specialist at Kindred Hospitals Resource Overhead
Description
Job Summary
Responsible for managing outsource denial management vendor invoicing, documentation of accounts and inventory flow. When non-clinical denials are received from third party payers (government and non-government) the Claims Denial Specialist will be responsible for managing the payer requests in a timely manner to ensure accurate and timely responses.
Essential Functions
- Excellent writing and organizational skills.
- Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
- Knowledge of accreditation standards and compliance requirements.
- Knowledge of government and non-government payer practices, regulations, standards and reimbursement processes.
- Ability to review medical, financial and admission criteria documentation to prepare technical appeals or documentation required to timely adjudicate the claim.
- Regularly review periodicals, web sites and other media for changes in current guidelines.
- Provide education to management relating to payer trends and patterns so Centralized Business Office and Managed Care can address to assist with timelier liquidated of claim.
Knowledge/Skills/Abilities/Expectations
- Working knowledge of healthcare law.
- Strong written and verbal communication skills.
- Ability to work with individuals at all levels of the organization.
- Knowledge of long-term acute care industry.
- Knowledge of state and federal regulations.
- Proficient computer skills.
- Ability to analyze, research, and interpret.
- Approximate percent of time required to travel: 0
- Must read, write and speak fluent English.
- Must have good and regular attendance.
- Performs other related duties as assigned.
Qualifications
Education
- Bachelor's degree in clinical field required
Licenses/Certification
- Registered Nurse preferred but not required
Experience
- 3 years' experience in clinical setting preferred
- 1 years' experience in hospital case management preferred
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