The Denial & Recovery Specialist 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 reviews, and other day-to-day responsibilities.

In addition to meticulous attention to detail, the billing specialist must have excellent communication skills to address provider and client inquiries, resolve issues, and provide relevant account updates.

Responsibilities :

• 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 correctly within 60 days of the billed service.
• Review and submit accurate billing, ERAs, etc.
• Check for accuracy in 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).
• Submit CMS forms to secondary and tertiary payers within 15 days of receiving denials from primary insurance.
• Utilize online healthcare databases and other resources for verification and claim status.
• Maintain strict confidentiality and adhere to all HIPAA guidelines and regulations.
• Submit a weekly update to the Operating Officer on completed claims activities and outstanding items with an action plan for completion, used for comparing eligible paid hours.
• Answer phone lines, and take messages throughout the day.
• Communicate via email, phone, or fax with different providers.
• Submit prior authorization requests for providers if needed.
• Perform other duties as assigned by management.

Skills Required :

• 2 or more years of proven experience as a claims or denial specialist.
• Adherence to laws and best practices regarding 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 attention to detail and trustworthiness.
• Ability to multitask and manage billing for different agencies.
• High school diploma with experience or higher accepted.

Would like knowledge of EHR programs