Job Summary:

The Denials Manager's responsibilities include identifying all denials sent to APS Work queues and review and redistribute them appropriately to the parties who can correct them, including but not limited to Revenue cycle, Billing Vendor, Revenue Integrity, and providers. Work those easy fixes and resubmit to insurance carriers efficiently and on time. Responsible for filing appeals where necessary and follow up with the insurance carriers. Monitor and report on Denials. Coordinates with Billing Vendor, Revenue Integrity, Revenue Cycle, Providers and Practice Managers to ensure that all denials are worked timely.

Responsibilities:

• Overall planning, organizing and directing daily work assignments of all Technical Denial work queue items and redistribute to other departments for action/correction.
• Conduct analysis on Clinical/Technical Denials and provide/recommend opportunities for improvement.
• Coordinate with APS billing vendor, Revenue Integrity and Revenue Cycle to ensure that all denials are handled appropriately and in a timely manner.
• Maintaining and developing relationships with all practice managers and directors.
• Preparation and filing of clinical appeals where necessary.
• Provide training and education to Practice Staff and Managers when necessary, i.e. entering authorization code in the appropriate field, NDC updates, and correct insurance.
• Oversee and Monitor workflow and measure the productivity of denials management.
• Create a trend report on denials on a monthly basis based on the type of denials and monitor for improvement.
• Attend meetings with billing vendor/Cerner/APS/Coding to discuss all issues related to denials.
• Staying current with all regulation, prevention and management of denial practices, and various insurance companies' policies in terms of reimbursement for professional services.
• Utilizes denial reports to assess root causes and identify trends. Shares findings with stakeholders.
• Provide advice and act as subject matter expert.
• Performs all other duties as assigned.

Experience:

3 to 5 years experience in healthcare billing/denial/coding experience required.

Education:

Bachelor's degree in Finance, Business Administration, Healthcare Administration, or related field, required.

Licenses / Certifications:

CPC (Certified Professional coder) preferred but not required.

Other:

Proficient in all Microsoft Office applications as well as medical office software. Proficient in Cerner System highly desirable. Strong interpersonal and organizational skills. Excellent customer service skills. The ability to work in a fast-paced environment.

About Us:

NorthEast Provider Solutions Inc.

Benefits:

We offer a comprehensive compensation and benefits package that includes:

• Health Insurance
• Dental
• Vision
• Retirement Savings Plan
• Flexible Savings Account
• Paid Time Off
• Holidays
• Tuition Reimbursement