The Denial & Recovery Manager will assist each organization in recovering owed revenue and identifying the responsible parties, often managing multiple client accounts during shifts. The ideal candidate must possess excellent accounting and organizational skills to accurately handle incoming payments, outgoing claims, database updates, denial, or collections review, among other day-to-day responsibilities.
Responsibilities:
Oversees, completes, and directs the denial and recovery management process and data processing functions; manages in-house denial efforts to meet the organization’s business goals & corporate established collection and net days in accounts receivable goals.
Follow up on all claims older than 30 days of age using the EHR system for each client. Utilize EHR systems such as RXNT, Therapy Notes, Share Note, Office Ally, Availity, Novita sphere, etc.
Ensure all claims are paid at the correct rate within 60 days of the billed service.
Coordinate with billing, credentialing, denial, and recovery departments, and/or healthcare providers regarding insurance claims – contacting providers regarding outstanding balances due to front office, provider, or staff errors.
Check accuracy for charge entry.
Review all EOBs and ERAs sent to the Denial team for necessary corrections (e.g., inappropriate denial, incorrect payment rate, correct place of service or modifier).
Use online healthcare databases and other resources for verification and claim status.
Maintain strict confidentiality and adhere to all HIPAA guidelines/regulations.
Identify denial patterns and escalate to BOD as appropriate with sufficient information for additional follow-up and/or root cause resolution.
Answer phone lines throughout the day, take messages.
Communicate via email, phone, or fax with different providers.
Maintain effective communication and supportive working relationships with business office staff, other departments, and insurance companies.
Manage own workload exceptionally well, to the extent that support is often available to others; Show initiative in offering support and expertise to coworkers and other departments.
Stay up to date on behavioral health provider news and denial errors, global denial updates.
Review, schedule, and approval of all time submissions weekly for staff in the department.
Other duties as assigned by management.
Skills Required:
7 or more years of proven experience as a claims or denial specialist or in Business office management.
Adherence to laws and best practices regarding dealing with customers and data.
Comfortable with numbers and processing financial information.
Excellent knowledge of MS Office (particularly Excel) and EHR software.
Proficiency in English.
Results-driven and patient.
High degree of attention to detail and trustworthiness.
Ability to multitask and manage billing for different agencies.
High school diploma with experience or higher accepted.
Experience level:
5 years