Responsible for pursuing denied accounts and timely follow-up to address payment delays.
Updating/reprocessing claims and submitting reconsiderations/appeals within proper filing timeframe.
Knowledgeable of payer requirements and experienced in claim resolution.
Identifying, expediting, and escalating trends to management.
Demonstrating exceptional relationships with external/internal payers and internal departments.
Monitoring denial work queues and reporting in accordance with assignments from direct supervisor.
Participating in departmental huddles and team meetings involving discussion of A/R processes and denial trends.
Maintaining required levels of productivity and quality while managing tasks in work queues to ensure timeliness of follow-up and appeals.
Organizing denial/rejection related tasks to identify patterns or work efficiently (e.g., by current procedural terminology, diagnosis, payer, etc.).
Identifying and monitoring negative patterns in denials/rejections and escalating accordingly to PFS management.
Utilizing identified and known resources to accomplish follow-up on tasks.
Complying with all government regulatory mandated requirements for billing and collections.

High School diploma or equivalent or post-high school diploma / highest degree earned.
Five (5) years hospital/physician billing office and/or healthcare revenue cycle experience.
Certified Revenue Cycle Analyst (CRCA) preferred.
Proficient computer skills (spreadsheets and excel pivot table skills).
Data entry skills.
Mathematical skills.
Medical terminology/ICD Coding.
Knowledge of current trends and developments in the healthcare industry and specifically as it relates to denials/appeals through appropriate literature and professional development activities preferred.
Self-motivation and ability to demonstrate initiative, excellent time management skills, and organizational capabilities.
Ability to review/understand all pertinent information such as insurance carrier explanation of benefits, insurance carrier denial letters and electronic remits to ensure denials are worked in a timely manner and reconsideration/appeals for the denial claims are submitted appropriately preferred.
Comprehensive understanding of remittance and remark codes preferred.
Knowledge of payer edits, rejections, rules, and how to appropriately respond to each preferred.
Working knowledge of UB-04 claim forms preferred.

Patient Financial Services Denials and Appeals Specialist

Key skills