Claims Denial Management Specialist
HealthDrive - Framingham, MA
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HealthDrivedelivers on-site dentistry, optometry, podiatry, audiology, and behavioral health services to residents in long-term care, skilled nursing, and assisted living facilities. Each specialty offered by HealthDrive is one that directly impacts the quality of daily life for the deserving residents we serve. HealthDrive connects patients in need of vital healthcare to doctors committed to dignity and excellence. Conveniently located off Route 9, close to routes 90 and 495 in a spacious modern office! Workout center available in the building! PPO Medical, Dental, and Vision plans are available as well as a generous PTO policy.We are seeking a Full-time Claims Denial Management Specialist in our Corporate office in Framingham MA. Responsible for daily follow-up on large volumes of unpaid/partially paid or denied claims for Optometry, Podiatry, Audiology, and Dental services from insurance plans in 17+states. Follow-up on claims billed to Medicare Replacement, BCBS, Private Insurance and Medicaid / Medicaid Managed Care plans including but not limited to: AARP, Aetna, AmeriHealth, Anthem, Argus Vision, BCBS, Cigna, CCA, Davis Vision, Delta Dental, DentaQuest, Envolve/Opticare, EyeMed, Fallon, Humana, MEDEX, Molina, NHP, Optum, Priority Health, Spectera, Superior Vision, Senior Whole Health, Tricare, Tufts, UCARE, United Healthcare, WellCare, Well Sense, VSP, State Medicaid and Medicaid Managed Care plans. Identify, investigate, and follow up with insurance plans to expedite resolution of denied, incorrectly paid or unpaid claims to obtain payment in a timely manner.Submit corrected claims and appeals online or on paper within the specific insurance plan’s timely filing / appeal limits.Become the expert on the claim requirements for assigned insurance plans.Utilize insurance plan website (s) to check eligibility, claim status, submit online appeals, or provide Explanation of Benefits (EOB’s) / Explanation of Payments (EOP’s) required for processing secondary/tertiary claims.Identify and communicate denial and payment trends by insurance plan, review and resolve denials by reason code. Perform daily review and take appropriate action(s) to resolve nonpayment issues on large volumes of claims to meet assigned daily productivity objectives.Work professionally and cooperatively with facilities, responsible parties, insurance carriers and all internal and external customers.Assist with other duties and/or projects to meet business needs / objectivesExtensive knowledge of Third-Party billing practices and regulations for Medicare Replacement, Medicare Supplemental, BCBS, Private Insurance, Medicaid, and Medicaid Managed Care plansStrong knowledge of adjustment and denial reason codes from Electronic Remittance Advices (ERA/835 files) and from paper Explanation of benefits (EOB’s) / Explanation of payments (EOP’s), CPT and ICD10 codesExcellent interpersonal and communication skills with professional demeanor and positive attitudeStrong collaborator with ability to establish priorities, effectively multitask to meet objectives and deadlines. Strong time management and organizational skills; demonstrated ability to independently prioritize.Excellent attention to detail with exceptional follow-up, problem-solving and analytical skillsStrong computer skills, proficiency with Excel, Outlook and Word, Medical Billing Software, insurance plan websites and provider manualsStrong work ethic with exemplary attendance recordHigh school diploma required; Associates degree is preferred.Prefer minimum of 5 years; experience in professional physician multispecialty group or hospital setting handling medical claim denial resolution.Knowledge of HIPAA regulations and patient privacy rulesPhysical Requirements:Ability to sit and process data in computer for extended periods of time.Ability to use office equipment such as computer, phone, fax, and copier.
Created: 2024-09-07