Denial Management Specialist

The Denial Management Specialist will have prior experience in a revenue cycle role and be responsible for resolving, preventing and fixing specific denial types for multiple Payors and therapies. Investigate denied third party claims and take actions to overturn denials for payment.

This is a full-time remote role.

Essential Duties & Responsibilities:

• Communicate global payor issues with the Payor Relations team.
• Ensure all denials are fully worked. Denials include but are not limited to: Patient Ins Termed, Additional Information needed, medical record requests, COB denials and non-covered services denials.
• Able to build and maintain relationships with payer representatives in coordination with our RCM and Contracting teams for projects involving payer contact.
• Basic knowledge of Microsoft Excel to manipulate reports to maximize efficiencies.
• Respond to internal and external customer questions professionally, timely and accurately.

The ideal candidate will have:

• Ability to overturn denied third party claims.
• Detail oriented, highly organized, resourceful and flexible to adapt to ongoing project changes or other departmental needs
• Problem-solving: solutions oriented, clear communication, communicates a sense of authority through subject matter expertise, resourcefulness
• Troubleshooting: ability to anticipate issues, research and implement creative solutions.
• Self-Motivated
• Superior knowledge of software and other systems and portals used within RCM.
• Clear, effective written and verbal communication skills
• Ability to work independently while handling multiple projects and tasks concurrently and timely.
• Proficiency in MS Office, especially Word, Excel, and PowerPoint, with a focus on creating and developing spreadsheets, presentations, and reports effectively and efficiently
• Strong organization
• Strong under pressure, can continue working amidst stressful environment
• Knowledge of specialty infusion/ renal dialysis
• Personable, gets along with diverse individuals and teams

Skills:

• 3-5 years Healthcare experience in a home infusion, DME, or other therapy related to revenue cycle processes
• Minimum of 5 years hands-on experience in a Revenue Cycle role preferred.
• Bachelor’s Degree or related healthcare work experience preferred.
• Proficiency, daily use with Microsoft Excel, Word
• Proficiency, daily use with CPR+ or similar platform

Pentec Health provides a comprehensive compensation and full benefits package. The estimated hourly pay for this role is $20.00-$26.00. Actual pay will be based on several factors such as qualifications and skills for the role plus geographic location. Benefits include but are not limited to: medical, dental, vision, 401k match, PTO, paid holidays, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Pentec Health, Inc. is and Equal Employment Opportunity Employer

Critical features of this job are described under the headings below. They may be subject to change at any time due to reasonable accommodation or other reasons