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From Home Denial Management Jobs (NOW HIRING)

Carle Health

RN -UM/Clinical Denial Mgmt

Champaign, IL · On-site

$35.87 - $58.37/hr

Overview Responsible for the oversight, coordination, and management of the functional and ... from each new employee's Form I-9 to confirm work authorization. | For more information: human ...

Adobecw

Revenue Cycle Management Director

Phoenix, AZ · On-site

$130 - $180/hr

... in-home and in-clinic wellness assessments, preventative care, transitional care, and social ... Develop and oversee the organization's denial management program, including trend analysis, root ...

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A-Line Staffing Solutions

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REMOTE Pharmacist- PBM Prior Authorization required

Las Vegas, NV · On-site

$53 - $55/hr

FULLY REMOTE - WORK FROM HOME, 40 hours per week. Job Highlights * 100% Remote / Work from Home ... approval & denial management processes. * Handles inbound phone calls and escalations from ...

SYNERGY CONSULTING SERVICES INC

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Home Health Billing, Collections RCM Manager

Miami, FL · On-site

$52K - $60K/yr

... claim denial management and supervise billers/collectors. Extensive use of multiple EMR systems and payer / government portals. Candidate must have proven analytical skills that will include using ...

Healthrise

Clinical Denials Specialist

Farmington Hills, MI · On-site

$17.75 - $23.50/hr

... or denial management. Physical Demands and Work Environment * Work Environment: This job operates in a professional home environment. This role routinely uses standard office equipment such as ...

Nationwide Children's Hospital

Schedule: Monday-Friday (8:00am-4:30pm) Position is work from home after a 90 day in-office ... Assists with retrospective reviews and denial management to maintain appropriate and cost-effective ...

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MSRDP Clinical Denial Management Specialist III - MSRDP Medicine & Ancillary Follow-Up

UT Southwestern Medical Center

Dallas, TX • On-site

$18 - $23.25/hr

Full-time

Re-posted 10 days ago

UT Southwestern rating

7.9

Company rating: 7.9 out of 10

Based on 152 frontline employees who took The Breakroom Quiz

110th of 898 rated healthcare providers

Job description

Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information
Salary
Salary Negotiable
Experience and Education
High School diploma or equivalent, Associates degree preferred.
Six (6) years medical billing or collections experience. Two (2) years must include denial management and proven knowledge of billing/coding guidelines for complex E&M services, diagnostic studies, and/or minor surgical procedures that encompasses CPT and ICD-10 codes, modifiers, and payer specific rules.
Experience involving complex diagnostic studies, endoscopic, interventional and/or surgical procedures preferred.
Work requires experience in Medical Billing, Accounts Receivables, and/or Collections within a healthcare or insurance environment.
Work requires knowledge of CMS 1500, ICD-10, and CPT coding.
Requires working knowledge of Epic Resolute.
Job Duties
  • Review, research and resolve coding denials for complex diagnostic studies, endoscopic, interventional and/or major surgical procedures. This includes denials related to the billed E&M, CPT, diagnosis, and modifier.
  • Denial types could include bundling, concurrent care, frequency and limited coverage.
  • Prepare and submit claim appeals, based on payor guidelines, on complex coding denials. Identify denial, payment, and coding trends in an effort to decrease denials and maximize collections.
  • Clinical denial review.
  • Insurance follow up on denied claims, payer appeals and research to prevent the denials from occurring in the future.
  • Contact payers, via website, phone and/or correspondence, regarding reimbursement of claims denied for coding related reasons. Interpret
  • Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.
  • Requires knowledge of carrier specific claim appeal guidelines. This includes Claim Logic, internet, and paper/fax processes.
  • Requires proven analytical, and decision making skills to determine what selective clinical information must be submitted to properly appeal the denial.
  • Requires proven knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of the specialty service line.
  • This position requires clear and concise written and oral communication with payors, providers, and billing staff to insure resolution of complex coding denials.
  • Requires the ability to read and interpret E&M notes, complex diagnostic study results, endoscopic and interventional results and/or major surgical operative notes. Based on the documentation review, confirm or change the billed CPT code(s), diagnosis code(s) and modifiers (if applicable) in order to attain denial resolution.
  • Requires proven knowledge of the specialty specific service line documentation requirements.
  • Must be familiar with the Medicare and Medicaid teaching physician documentation billing rules within 60 days of hire.
  • Serves as a resource to the FERC Team Leads, Compliance Auditors, Medical Collectors and MSRDP Clinical Denials Management Specialist I & II.
  • Requires a billing and coding knowledge level that provides guidance on and resolution to resolve claim denials and rejections.
  • Makes necessary adjustments as required by plan reimbursement.
  • Duties performed may include one or more of the following core functions: (a) Directly interacting with or caring for patients; (b) Directly interacting with or caring for human-subjects research participants; (c) Regularly maintaining, modifying, releasing or similarly affecting patient records (including patient financial records); or (d) Regularly maintaining, modifying, releasing or similarly affecting human-subjects research records.
  • Perform other duties as assigned.

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; gender, including sexual harassment; age; disability; citizenship; and veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

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