Insurance Denials Specialist

Join Cerebral Staffing, LLC for our direct client in Minneapolis, MN as an Insurance Denials Specialist

Location: Minneapolis, MN

Duration Of Role: 13 weeks

Pay: $21-22p/hour

Hours: 40 hours per week

DUTIES AND RESPONSIBILITIES

The Insurance Denials Specialist is responsible for reviewing all assigned denials and working toward resolution. Prepares and sends documentation required for appeals, including data from the patient's health record, specific payer policies, and other materials as needed. Works closely with both the coding staff to understand the coding as well as the CBO teams to optimize reimbursement. Notes any specific payer or CPT code trends and notifies leads/manager to work toward resolution. Helps identify any coder education that may be required if it's identifiable in the denials data and keeps team leadership informed. Works to resolve denials the first time, but also understands processes to escalate with specific insurance plans for second-level appeals as needed.
1.    Reviews denial reasons, validates accurate coding, and initiates appeals process for claims to ensure prompt and accurate payment.
•    Works to understand denial reason using provided information from payer
•    If unable to get a reasonable denial reason from the data in the system, will, at times, contact the payer directly to ask for additional information
•    Collaborates with coding team, as needed, to ensure understanding of initial code selection and if updates are required
•    Researches payer-specific coverage policies to determine if an appeal is warranted
•    Determines appropriate documentation required for an effective appeal, including medical records, payer coverage policy, specialty-specific information and provides it to the CBO team for the appeals process
2.    Reviews all patient complaints and works to ensure a positive customer service experience by fully answering patient queries
•    Discusses patient complaints with leadership team as needed
•    Fully investigates code selection and makes changes if appropriate
•    Clearly communicates coding response to patient complaints back to the CBO teams via tasks in Epic
3.    Identifies denial trends based on specific payer and/or services rendered
•    Notifies leadership team of specific trends in order for appropriate next steps
•    Collaborates between CBO and leadership team to address payer-specific issues and helps identify potential solutions
4.    Performs other duties including Performance Goals developed by manager and employee and reported in the employee's Performance Review as part of Performance Management tools
•    Maintains core/universal competencies and completes any new required learnings.
•    Demonstrates all critical competencies and new required learnings."

Skills:

Universal Competencies   
Commitment to Patient Centered Care
•    Always puts patient/customer needs first.
•    Demonstrates awareness of different patient/customer needs and desires, and adjusts approach to provide care, including those related to cultural orientation, race, primary language, age, size, gender, gender identity, physical capability, sexual orientation, spiritual belief, change in scope/complexity of patients, etc..
•    Helps improve processes to meet customer/patient needs and desires.
•    Respects confidentiality and HIPPA guidelines.
Follows and Supports Code of Conduct
•    Supports  values of Service, Innovation and Respect.
•    Contributes to an ethical work environment by demonstrating respect for the law and for each other.
•    Maintains a welcoming work environment that is physically and emotionally safe and free from discrimination and harassment.
•    Reports illegal or unethical conduct or suspected violations of policy or Code of Conduct.
•    Models integrity in patient care, business and regulatory compliance.
•    Maintains the integrity and strict confidentiality of patient records and business information.   
Commitment to Operational Excellence
•    Understands and supports mission and vision of
•    Promotes positive work environment and employee recognition.
•    Demonstrates interpersonal values of compassion, respect, teamwork and diversity.   
•    Demonstrates pursuit of innovation and excellence using inquiry and mentorship

Education:

Required: High school diploma or GED.
•    CPC, CCS-P, RHIT, or equivalent.
Experience: Two years in insurance resolution, patient accounting or medical billing with knowledge of medical terminology, financial securing, collections and patient interaction; or new graduate from an HIM-related program with equivalent knowledge.

 *Up to date immunizations required upon offer including: MMR (2 Doses), Varicella (2 Doses), COVID vaccine, and Flu Shot. Other onboarding requirements include: TB Test and Drug Test*

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