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Working Hours: 8:00am - 4:30pm (Monday - Friday)
Occasional extended hours may be required to meet business needs.
Training Hours: 8:00am - 4:30pm (Monday - Friday)
Occasional extended hours may be required to meet business needs.
Company Mission: To be the best provider of comprehensive and innovative clinical laboratory services for the prevention, diagnosis and treatment of complex chronic disease.
Company Vision: The Genova Diagnostics team will improve the lives and well-being of patients by bringing insights to the complexity of health.
Position Summary:
The Denial Specialist is responsible for working third party A/R and denials to ensure appropriate payment for Genova’s claims and timely resolution of third party accounts receivable according to Genova policy. Completes denial follow up and no response research with insurance carriers, patients, and clients to ensure claims are processed and to obtain adjudication information. He/she re-submits claims and appeals as necessary to ensure appropriate and timely reimbursement. The Denial Specialist is responsible for maintaining the 48 hour turn-around time requirement for the daily posting of all payment/adjustment categories including check, EFT, and Zero payment, Patients, Consumers, EOB’s and remittances manually and electronically. Interpretation of the Explanation of Benefits (EOB) and claim adjudication will be required in order to post remittances at the CPT code and denial code level. The position is responsible for the accurate posting of payments and adjustments to the correct invoices. This position supports billing processes and other A/R processes as necessary to ensure excellent cash collections and DSO performance.
Essential Duties and Responsibilities:
Responsibilities include but are not limited to the following:
Technical
Other
Supervisory Responsibilities:
This job has no direct supervisory responsibilities but does require close communication with all ARBO teams.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Candidates must have the following skills and attributes: experience in insurance billing and knowledge of CPT and ICD-10 coding; knowledge of medical insurance reimbursement methods and processes; complete understanding of medical necessity and non-covered service; data entry and basic accounting skills; strong analytical skills for problem solving; process oriented problem solver; high level of commitment; and a strong desire for professionalism, quality, and achievement. He/she must be able to communicate effectively with an emphasis on customer service. 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.
Education and/or Experience:
This position requires a high school education. Associates degree in business preferred, relevant work experience will be substitutable for the appropriate candidate. Candidates must have one year of experience in cashiering and refunds application within a Medical Office setting. One year knowledge and experience with posting 3rd party payments and adjustments, manually and electronically. One year knowledge and experience with Insurance EOB interpretation and medical claim reimbursement methods and allowances. Candidates must have a minimum of one year of practical experience in insurance billing and follow-up.
Computer Skills:
To perform this job successfully candidates should be comfortable with standard Windows-based software packages of Word and Excel.
Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit for extended periods of time; use hands to finger, handle, or feel; reach with hands and arms; talk; hear. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision and ability to adjust focus.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Full Time
Ancillary Healthcare
$45k-59k (estimate)
04/17/2024
06/15/2024
gdx.net
ASHEVILLE, NC
500 - 1,000
1987
Private
CRAIG THIEL
$50M - $200M
Ancillary Healthcare
Genova Diagnostics is a clinical laboratory, provides medical diagnostic testing services for physicians and healthcare providers.
The following is the career advancement route for Denial Specialist positions, which can be used as a reference in future career path planning. As a Denial Specialist, it can be promoted into senior positions as a Patient Accounts Supervisor that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Denial Specialist. You can explore the career advancement for a Denial Specialist below and select your interested title to get hiring information.