What are the responsibilities and job description for the Denials Specialist, RCM position at Mayfield Clinic?
This Specialist will join the claims follow-up team and be responsible for processing insurance company remittances, denial follow-up, and other tasks related to insurance claim accounts receivable. The Revenue Cycle Management (RCM) team is looking for someone with insurance claims denials follow-up experience, plus critical thinking skills, attention to detail, and the ability to learn quickly and adapt to a changing environment.
Education/Experience:
- High School Diploma required
- Two years' experience in healthcare administration/revenue cycle
- CRCR Certification preferred
Skills:
- Demonstrates excellent customer service
- Ability to convey empathy
- Strong problem-solving, problem-prevention, and decision-making skills
- Ability to manage and prioritize multiple tasks in fast-paced environment
- Excellent oral and written communication skills
- Ability to maintain composure and restore calm in a stressful situation
- Uses good judgment and diplomacy when dealing with others
- Desire and ability to work in a team environment
- Computer proficient with the ability to learn multiple software applications
- Ability to work with minimal supervision
Primary Responsibilities: The purpose of this position is to execute follow-up actions on insurance claims; expedite positive cash flow, maximize reimbursement, and resolve claims denials and issues with payers in the assigned area of the Revenue Cycle claims process.
Essential Functions:
- Help develop &maintain a corporate culture that supports the mission and values of Mayfield Clinic
- Follow up on submitted electronic & hard copy claims in an accurate, timely manner; submit appeals, make corrections to overturn denials, post payments, & process takeback requests as required.
- Make all necessary corrections to claims that do not pass billing edits/payer requirements & resubmit to payers.
- Contact payers regarding unpaid claims. Research and/or ensure that questions and requests for information are addressed in a timely & professional manner to ensure resolution & reimbursement.
- Ensure timely & accurate posting of remittance advice information & follow up as needed to ensure full, expected reimbursement for services provided.
- Maintain documentation and update our practice management system for appropriate claims submission & other pertinent information to identify action taken.
- Make necessary adjustments as appropriately required by plan reimbursement & company policy.
- Prioritize claims based on aging and outstanding dollar amounts or as directed by management.
- Research & initiate requests for refunds for accounts with credit balances.
- Answer & initiate phone inquiries regarding bills, charges, claims, and account status.
- Update data in the practice management system as required.
- Contribute to the team environment by performing other duties as assigned.
Physical Requirements:
- Hand Movement, including repetitive motions, grasping, holding, and finger dexterity. Reading, Writing, and Hand-Eye Coordination. Vision, including color distinction, and visual inspection. Hearing, Talking, Sitting, Lifting up to 10 pounds, Bending, Reaching
Mayfield Clinic Mission: To provide the best neurological care for our patients through:
- Superior clinical outcomes
- Compassionate patient care
- Education and research
- Innovation
Mayfield Clinic Values: All associates who are affiliated with the Mayfield Clinic must agree to use these values as a basis for their employment, and recognize that they are part of the associates annual Performance Review and Development Plan:
- Integrity: We commit to honest and ethical behavior in all of our endeavors and interactions.
- Excellence: We commit to the highest level of performance and continuous improvement.
- Respect: We embrace the importance of all individuals & value their diverse backgrounds, skills & contributions.
- Compassion: We commit to being compassionate and empathetic in all of our interactions.
- Collaboration: We embrace teamwork, mentoring, cooperation, sharing of expertise, & empowerment.