Certified denial re Covery spe CialistSales Rain BPO Inc

CERTIFIED DENIAL RECOVERY SPECIALIST
 
We are seeking an experienced and detail-oriented Denials Recovery Specialist to join our team in Cebu!
 
The Certified Denial Recovery Specialist is responsible for the day-to-day activities and resolution of assigned medical claims including denied, unpaid and underpaid accounts. This role will report to the country Manager of Revenue Cycle Operations. The Certified Denial Recovery Specialist will utilize intermediate skills in denial analysis and resolution of all assigned patient accounts based on contractual obligations.
 
Company Overview:
 
For over 20 years, we've been a leading middle market revenue cycle management (RCM) vendor, providing comprehensive financial and operational solutions to health systems, physician groups, or specialty medical practices. Our mission is to improve the overall financial health of our clients by offering customized, data-driven, and tech-enabled recovery of denied claims and aged receivables. We utilize our deep expertise in revenue cycle to help transform our client's revenue cycle processes to achieve sustained reductions in denial rates.
 
Key Responsibilities:
Proactively reviewing and researching all accounts assigned and completing all necessary activity to resolve the claim.
This includes, bill correction and resubmission, generation of appeal letters, written and oral correspondence with payers, calculating adjustments and forwarding appropriate requests to client, responding to documentation requests from payers, transfer of balance to patient liability or appropriate financial class as determined by review and research.
Researching client data systems to determine current status, history and past actions on claim.
Determining appropriate action to resolve denial.
Investigating and/or ensuring that questions and requests for information are responded to in a timely and professional manner resulting in accurate resolution of assigned accounts.
Perform ongoing monitoring of accounts worked to ensure maximization of collection dollars through appropriate follow-up and documentation of actions taken in client and/or HBS computer systems as appropriate.
Review remittance advices for denials and trends for the payers assigned. Referring all payer issues/problems to Leadership in a timely manner, making recommendations to the Project Director/Revenue Cycle Director for resolution and elimination of denials where possible.
Researching, reviewing, and adhering to all federal, state, and local regulatory collection guidelines, as well as payer specific billing/collection guidelines.
Provide customer service, including timely response to telephone calls, e-mails, and other verbal or written correspondence. Resolve client complaints to satisfaction.
Participate in special projects or other responsibilities as needed or assigned.
Carries out the mission, vision, values, and quality commitment of HBS.
Practice HIPAA compliance.
Attend staff and other professional meetings, including technical or professional classes, workshops, or seminars, to exchange information and improve technical or professional skills.
Qualifications:
Must have a High School Diploma. College degrees are strongly preferred.
Minimum of 1 years working experience in dealing with denied claims.
Solid verbal / written communication skills in English.
Ability to use a computer, facsimile and copy machine.
Intermediate Microsoft Office skills (Excel, Word, Outlook).
Join our dynamic organization as a Denial Recovery Specialist, and contribute to the enhancement of coding quality within the revenue cycle, ensuring accurate and compliant coding practices that support optimal healthcare outcomes.
 
We offer a competitive salary and benefits package, including HMO, and opportunities for professional growth and development. Join our team and contribute to our mission of empowering healthcare providers to optimize their revenue cycle and achieve financial success.