Medical Billing Claims Denial Specialist

JOB DESCRIPTION:

MedBTS.com is seeking a process driven Medical Billing Claims Denial Specialist who has extensive revenue cycle management (RCM)experience. As a core component and critical member of our RCM management team, attitude, demeanor and willingness to be accountable are critical aspects of this position. The Medical Billing Claims Denial Specialist will focus on medical insurance claims denial to include but not be limited to analyzing initial denial responses, collaborating with the MedBTS medical coding teams, fully investigating code selections, making coding changes, identifying and documenting claim denial trends and reporting claim denial trends and KPIs to MedBTS operations executive management. Qualified candidates must be able to interact with clients, patients, staff members, attorneys, and insurance companies, be dependable, detailed oriented, problem solve and improve processes.

RESPONSIBILITIES:

Duties include, but are not limited to:

  • Schedule: Monday – Friday, day shift (40 hours/week).
  • Reviews denial reasons, validates accurate coding, and initiates appeals process for claims to ensure prompt and accurate payment.
  • Works to understand denial reason using provided information from payer.
  • If unable to get a reasonable denial reason from the data in the system, will, at times, contact the payer directly to ask for additional information.
  • Collaborates with coding team, as needed, to ensure understanding of initial code selection and if updates are required.
  • Reviews all patient complaints and works to ensure a positive customer service experience by fully answering patient queries.
  • Discusses patient complaints with leadership team as needed.
  • Fully investigates code selection and makes changes if appropriate.
  • Clearly communicates coding response to patient complaints back to the CBO teams via tasks in Epic.
  • Identifies denial trends based on specific payer and/or services rendered.

QUALIFICATIONS:

The preferred qualifications are listed below, but are not limited to:

  • Associates degree or higher in Business Administration, Healthcare, or related field (Bachelor’s degree is preferred); this is a long-term, growth position.
  • Extensive knowledge of medical billing, coding and insurance company billing processes is required.
  • CPC, CCS-P, RHIT, or equivalent.
  • Two years in insurance resolution, patient accounting or medical billing with knowledge of medical terminology, financial securing, collections and patient interaction.
  • Intermediate to advanced skills in Microsoft Office Suite, including Microsoft Word, Microsoft Excel, and Microsoft Outlook.
  • Excellent professional oral, written (including grammar, punctuation, and sentence composition), and electronic communication skills.
  • Capable of remaining organized while prioritizing and executing multiple tasks to meet deadlines in a fast-paced, results-oriented environment.
  • Able to self-start and work independently.
  • Shift is daytime hours Mon-Fri, no weekends or holidays. This is a hybrid position with partial remote access and/or telecommuting.

Job Type:

Full-time; Salary

Benefits:

Yes

Schedule:

8 Hour Shift
Day shift
Monday to Friday

Experience:

Medical Billing, Revenue Cycle Management, Insurance Claims Analysis and Resolution: 5 years (7 to 10 years preferred)

Education:

Associates degree or higher in Business Administration, Healthcare, or related field (Bachelor’s degree is preferred)

Location:

Scottsdale, AZ 85254

Work Location:

Scottsdale Office / Home

Company’s website:

www.MedBTS.com

Benefit Conditions:

There is a 90 day waiting period before benefits become active

Work Type:

Hybrid (3 days office/2 days remote)

COMPANY OVERVIEW:

MedBTS.com is a leader in medical billing and revenue cycle management in Arizona and throughout the United States. MedBTS.com has created a unique niche in the marketplace for its in-depth knowledge, service excellence, and commitment to functioning like an in-house billing department. Second to our clients, MedBTS.com associates and team members are the core of our organization’s success and we would like to add more members to our team. The MedBTS.com culture fosters a “family first” environment where home life is a priority over work life. Excellence, professionalism, and results are rewarded with opportunity for career growth. Healthcare benefits are available as well as a matching 401K plan.

Visit our website at www.MedBTS.com. Please note prospective applicants may only be interviewed after resume is received; interviews are by appointment only.

MedBTS is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Job Application

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  • The employer offering this job opportunity is an equal opportunity employer that is committed to diversity in the workplace. In order to help us comply with government record keeping, reporting and other legal requirements, we ask that you complete the following information. The information will not be used in evaluating your application for employment. Completion of this form is voluntary.

    The employer may act as a government contractor and therefore is subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows and are hereafter referred to all together as “protected veterans”:
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    Employer will not discharge or otherwise discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, Employer employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of applicants or other employees to individuals who do not have such access, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation (internal or external), proceeding, hearing, or action or (c) consistent with Employer’s legal duty to do so 41 CFR 60-1.35(c).

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    I understand that this application will be fully considered, but its receipt does not imply that I will be offered employment. I also understand that, to be effective, such an offer must be made in writing by Employer Worldwide's ("Employer") Human Resources Department and, further that the offer is contingent upon my meeting all of the conditions outlined therein. If I am employed, I agree to conform to the policies, rules and regulations of Employer and consent to ongoing background inquiries. I understand that my employment may be terminated with or without cause and with or without notice, at any time, at the option of either Employer or myself. I also understand and agree that no supervisor, employee or officer of Employer has authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing. I authorize the company to investigate all statements contained herein and to make any additional background inquiries as may be appropriate or necessary as determined in the sole discretion of Employer. I understand that this investigation may include but is not necessarily limited to drug screening, reference checking, employment verification, income verification, a review of my criminal conviction record and inquiry relating to my character, general reputation and work habits, ethics and performance. I hereby release Employer, its subsidiaries and affiliates, their employees, officers, and agents from any liability whatsoever arising directly or indirectly from such inquiries. I certify that all of the information which I have given in this application is true and complete. I understand that any misstatement or omission may disqualify me for employment or result in my discharge.

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    Employer is an equal opportunity employer and an affirmative action employer. At Employer, we recruit, hire, train, promote and provide all other privileges of employment to qualified people without regard to age, race, color, creed, national origin, gender, gender identity, gender expression, disability, marital status, veteran status, alienage or citizenship status, ethnicity, familial status, religion, sexual orientation or any other classification for which discrimination is prohibited by Law.

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