Denial Management Specialist Job – Remote, KY

Why You'll Love This Job

Commonwealth Pain & Spine is a pain management network dedicated to improving the lives of our patients by treating their pain with the utmost respect and providing them with the most innovative, safe, responsible, and clinically proven pain relief possible. Our team of best-in-class physicians, administrators, and staff empathizes with the needs of our patients. We recognize that their pain is exhausting and debilitating and limits their quality of life. Relief from chronic pain is achievable in various degrees through our intelligent and multimodal team-based approach. Our entire team is committed to providing levels of patient satisfaction and overall clinical outcomes that far exceed the expectations of the medical community, referring physicians, and our customers.

Benefits:

Competitive compensation
Comprehensive Health/Vision/Dental insurance options
Great PTO plan PLUS Paid Holidays
401k and matching available

Commonwealth Pain and Spine is an Equal Employment Opportunity Employer!

Job Summary:
The Denial Management Specialist researches and analyzes denial data and coordinates denial recovery responsibilities.

Responsibilities

Researches and analyzes denial data and coordinates denial recovery responsibilities and report findings to leadership
Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denial
Develops reporting tools that effectively measure and monitor processes throughout the denials management process in order to support process improvement
Prioritizes activities to work overturns in a timely manner to alleviate untimely filings
Uses reports that categorize denials to assign tasks or personally work to overturn denials
Identifies and pursues opportunities for improvements in denial performance
Processes work lists to facilitate prompt intervention of insurance denials
Researches, responds, and documents insurer and patient correspondence/inquiry notes regarding coding coverage, benefits, and reimbursement on patient accounts
Research rejections included in EOBs for resolution and files appropriately
Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks
All other duties assigned including duties performed for affiliates, assigns, lessees, contractors or other third parties

Skills & Qualifications

3 plus years’ relevant work experience in healthcare, preferred
Knowledge of insurance plans and their rules
Basic CPT and ICD-10 coding knowledge
Working knowledge of EMR and/or billing systems
Exceptional communication and interpersonal skills to interact effectively and tactfully with all levels of employees, management staff, patients, vendors and the general public
Strong computer and phone skills, including Microsoft Office Suite experience
Responds timely to requests, emails, voicemails, etc.
Ability to handle multiple simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner
High integrity, including maintenance of confidential information
Regular and reliable attendance
Exercises professional judgment and demonstrates good problem-resolution skills
Eagerness and ability to work independently as well as part of a team with flexibility and willingness to learn and take initiative on variety of tasks and projects

Education:

Must have high school diploma or general education degree (GED)

Physical Requirements:
The physical demands of this position will include sitting and standing with occasional light to medium lifting. An employee must meet these requirements to successfully perform the essential duties of this job. Reasonable accommodation will be made in accordance with ADA rules and regulations.

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