Medical Billing Claims Denial Specialist
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.
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.
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.
8 Hour Shift
Monday to Friday
Medical Billing, Revenue Cycle Management, Insurance Claims Analysis and Resolution: 5 years (7 to 10 years preferred)
Associates degree or higher in Business Administration, Healthcare, or related field (Bachelor’s degree is preferred)
Scottsdale, AZ 85254
Scottsdale Office / Home
There is a 90 day waiting period before benefits become active
Hybrid (3 days office/2 days remote)
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.