Billing Specialist, Denials Management

About Sound:

Headquartered in Tacoma, WA, Sound Physicians is a physician-founded and led, national, multi-specialty medical group made up of more than 1,000 business colleagues and 4,000 physicians, APPs, CRNAs, and nurses practicing in 400-plus hospitals across 45 states. Founded in 2001, and with specialties in emergency and hospital medicine, critical care, anesthesia, and telemedicine, Sound has a reputation for innovating and leading through an ever-changing healthcare landscape — with patients at the center of the universe.

Sound Physicians offers a competitive benefits package inclusive of the items below, and more:

• Medical insurance, Dental insurance and Vision insurance
• Health care and dependent care flexible spending account
• 401(k) retirement savings plan with a company match
• Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy
• Ten company-paid holidays per year

About the Role:

The Denials Management Billing Specialist is responsible for following payor guidelines, legislation and regulations. They are responsible to track, trend and provide root cause analysis of denials received by payors. The Specialist works to eliminate denials allowing the organization to realize a decrease in the volume of denied accounts and dollars. Candidates should have experience with a minimum of one of our core service lines.

The Details:

In this role, you will be responsible for:

• Auditing denial adjustment requests from billing vendors, field operations and Sound Physician staff
• Working closely with Regional Operations, Contracting, Coding, Compliance, Payers, Billing companies and the Denials Committee to address issues affecting appropriate reimbursement
• Researching and analyzing denial trending and root cause by payer and region. Compiling data on inappropriate high volume denial types and working with payors, contracting and billing companies to resolve
• Maintaining documentation and participating in external audits in order to validate compliance with Sound Physicians policies surrounding denial adjustment requests
• Participating in Denials Management Committee meetings and providing feedback on areas requiring improvement for denials resolution
• Reviewing, working and trending vendor escalations
• Reviewing denial and payer trends for resolution
• Partnering with vendor to resolve denial and unpaid claims
• Reconciling approved adjustments to ensure that they have been posted and closed in the billing system timely, ensuring aging buckets do not increase
• Assisting department leadership with ad-hoc reports, research, analysis and special projects
• Managing time effectively to complete assignments within established time frames, optimizing collections, and meeting performance goals
• Other duties as assigned

What we are looking for:

A successful candidate will have a demonstrated track record of a combination of these values, knowledge, and experience:

Values:

• Work Ethic – Dedication to getting the job done well and on time, regardless of circumstances, a can-do attitude
• Communication: The ability to speak, write, and listen clearly and consistently
• Relationship Building and Maintenance: The ability to create and nourish healthy, strong relationships, as the face of Sound
• Teamwork: Demonstrates the ability to pull people together into highly effective teams along with ability to work in a highly matrixed organization
• Critical Thinking: Demonstrates the ability to be proactive, anticipate needs; ability to make good decisions with incomplete, ambiguous information
• Adaptability – Demonstrates flexibility and a willingness to change as circumstances evolve and be coachable
• Resourceful – Proactive willingness to utilize available information and tools to figure things out, not afraid to ask questions when necessary
• Commitment – Demonstrates a dedication to the job, project, organization, customer/clients, and co-workers

Knowledge:

• High school diploma or equivalent required
• Advanced understanding/knowledge of computer data entry, Microsoft Excel and ability to navigate through any business related software
• Knowledge and skilled in the use of a computers and related systems and software
• Maintains current knowledge base for regulations: state, federal, and commercial payors

Experience:

• 3-5 years’ experience in medical insurance authorization, billing, patient accounts or related role required
• Experience in denial and claims resolution required

Sound Physicians is an Equal Employment Opportunity (EEO) employer and is committed to diversity, equity, and inclusion at the bedside and in our workforce. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, sexual orientation, age, marital status, veteran status, disability status, or any other characteristic protected by federal, state, or local laws.

This job description reflects the present requirements of the position.  As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment. 

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