Denials Recovery Specialist, Binghamton

United Health Services is seeking a Denials Recovery Specialist to join our Revenue Cycle Team in Binghamton, NY. Denials Recovery Specialist’s key duties is focusing on claims denied and aged denials over 90 days from date of service. This is a Full Time position.

Shift: Days
Hours per week: 40
Salary range: $17.85 - $25.00/hour, depending on experience

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Denials Recovery Specialist Overview

Under the direction of the Denial’s Manager the Recoveries Specialist is Responsible for validating dispute/denied claims reasons as adjudicated from Patients Insurance Explanation of Benefits Review. Key duties will be focusing on claims denied and aged denials of 90+ from the original DOS. Responsibilities will include calling payors to confirm key denial reasons and solutions to adjudicate the resolution for the denied claim.

Denials Recovery Specialist Key Responsibilities and Expectations

• Validate denial reasons codes via remittance inquires or cart codes
• Ensure coding is reviewed/corrected as necessary for resubmitting denied claims for payment
• work to final resolution for aged denials greater than 90 days from date of service
• Generate an appeal based on the dispute reason and contract terms specific to the payor to include online reconsiderations.
• Follow specific payer guidelines for appeals submission
• Evaluate charges entry and contractual reimbursement to ensure correct payment transactions are accurate and not over/under paid.
• Escalate exhausted appeal efforts for resolution
• Works assigned payer projects as directed
• Preforms research and tracks trends of accounts worked to create process improvement or Margin Improvement for trends identified related to User, System and Payor related issues.
• Demonstrate commitment to organizational Values of Compassion, Trust, Respect, Teamwork, and Innovation

Position Qualifications

Minimum:

• High School Diploma or equivalent, with 3+ years of revenue cycle/ and or/ denials experience
• Intermediate understanding of Explanation of Benefits form (EOB)
• Federal and NY State Billing Requirements
• knowledge of hospital billing AND/OR Physician form requirements (UB-04/HCFA-1500)
• Strong understanding of ICD-10, HCPCS/CPT coding and medical terminology
• Intermediate Microsoft Office (Word, Excel) skills
• Intermediate business written communication to include correct use of grammar, tone, and punctuation.

Preferred:

• Bachelor’s Degree in Accounting, Communications, Business or, Marketing