Denials Specialist

Are you energized by solving problems? Do you love making a difference with your fellow teammates? Are you driven to change the standard of care in women’s health?
The Lactation Network is hiring a Denials Specialist. Under the direction of the Revenue Cycle Senior Manager, the Denials Specialist is a key member of the billing team and is responsible for actively investigating denials, creating and submitting appeals, and monitoring resolution and payment from participating insurance carriers.
We are a small, tight-knit, purpose-driven organization with aggressive growth goals in 2024 and beyond. We don’t have all the answers and we don’t expect you to, either. We do expect you to be curious, hardworking, and striving to be your best self.

Breakdown of the role

• Prepare appeals and follow-ups (60%). Compile all appropriate documents and submit, via mail or electronically, to the carriers in a timely manner. Initiate communication with our insurance partners to ensure all the necessary documentation for an appeal has been received and the appeal is processing for payment.
• Investigate appeals (20%). Identify, analyze, and research frequent root causes of denials and develop corrective action plans for overturning denials. Recognize common themes and lead cross-functional team conversations to prevent unnecessary denials.
• Reporting (20%). Develop and utilize reports to monitor the denials management process, such as prevention efforts, timely filing limits, and resolution success rate.

What you’ll do

• Compile appeals documentation. You’ll be responsible for compiling the documentation necessary to submit the appeals. Pulling medical records, itemized bills, and writing letters for submission verify all transactions posted electrically were done accurately. In doing so, you’ll identify root causes of errors and work with leadership toward permanent resolution of the issue.
• Hold insurance companies accountable. Through regular communication with the insurance carriers, you will verify TLN’s appeals are being processed in a timely manner, and are not being put on the back burner.
• Maintain records. Research, respond, and document insurer and patient correspondence/inquiry notes regarding coding coverage, benefits, and reimbursement on patient accounts.
• Identify trends. You will have the opportunity to assess the issues causing denials and report those up to your direct manager. Working with leadership, you will create permanent solutions that prevent denials and expedite the payment process for TLN.
• Stay up to date. Keep up with changes in the billing system, with insurance carriers, and/or with networks and clearly communicate issues and barriers.

What we expect from you
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Undergraduate degree
• 2-4 years of billing and/or collection experience working in a healthcare setting
• Experience working with payers including Commercial, Medicare, Medicare Advantage, Medicaid, and Managed Care
• Strong knowledge of Windows-based software applications. (E.g., Word, Excel…)
• Ability to multi-task and work in a fast-paced environment
• Excellent written and oral communication skills to effectively appeal denials and communicate with payors and other departments.
• Ability to outline and clearly communicate root causes of common problems and recommend solutions
• Capable of making timely, independent decisions
• Exceptional customer service skills required, including interpersonal conversation, patience, and empathy

What you can expect from us

• Unlimited PTO. We work hard. We’re passionate about what we’re building together. We also have lives outside work.
• ​​Benefits. Medical plus voluntary vision, dental. (We are a healthcare company, after all.)
• 401(k) with employer match. We’re planning for the future—and we want to help you do the same.
• Flexibility on remote work. We like spending time together in our West Town office and are transitioning to a flexible in-office culture for those who want to return to work in-person. Some team members will continue to work remotely (based upon role and/or geography).
• Wellness. You’ll have complimentary access to the leading app for meditations, sleep stories, and other wellness resources.
• Recharge. We have one designated “no meeting day” each week so you can take a break from videoconferencing and have some quiet time to focus.
• Professional development. We invest in our team by offering every employee access to a professional development budget.
• Competitive compensation. We’re looking for top talent.
• A growth environment. The sky’s the limit.

About The Lactation Network
The Lactation Network is setting a new standard for parents and lactation consultants alike. At TLN, our movement goes beyond any single outlet or tool. We activate education, connection, and advocacy to foster the new network of inclusive care between parents and IBCLCs; the network where every caregiver has the resources to thrive. TLN is powered by the largest network of IBCLCs in the country. Together, we are here to make sure families get the expert insurance covered lactation care that they deserve.
The Lactation Network is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Please note that TLN interview requests and job offers only originate from an @TLN.care email address (e.g jsmith@tln.care). TLN will also never ask for bank account information (routing, account numbers), social security numbers, passwords or any other sensitive information to be delivered over email, or phone.