Denial Management Clerk

Job Purpose

The Clerk supports the Denial Management Department in the denials process for client hospitals. In this role, the Clerk gathers and disseminates information from hospitals, physicians, and insurance companies pertaining to referred claims denied.

Duties and Responsibilities

• Manually enter new cases referred from clients into database as needed
• Update database with information gathered from correspondence
• Learn various applications, etc., including gAIge, Epic, Eagle, Epremis, Medi-Tech
• Set follow-up reminders in Outlook
• Review daily reports for updates and due dates
• Send updates on document requests received throughout the day
• Fax appeals and all pertinent documents
• Fax documentation to insurance carriers via portals, email, mail or fax
• Work within gAIge to update daily tasks assigned on work queue
• Log into all hospital applications and insurance carrier portals every two weeks
• Submit appeals, correspondence, and medical records via carrier portals
• Scan and label correspondence received daily via mail, email, or fax
• Navigate hospital applications to obtain balances, charges, and UB documents
• Download reports from portals for updates
• Assist with the outgoing mail process
• Scan documents into database
• Assist patients with questions related to statuses of their accounts
• Use, protect, and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

• High School Diploma or equivalent
• Must be courteous and possess a strong work ethic, with the ability to work in a fast-paced environment
• Possess clear, concise verbal and written communication skills
• Proficient in Microsoft Office applications (Word, Outlook, Excel, EPIC)
• Detail-oriented, resourceful, and analytical with ability to multitask
• Have strong organization and time-management skills
• Ability to learn proprietary databases

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.