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 BENEFITS-ELIGIBLE position.

Shift: Days
Hours per week: 40
Salary range: $17.85 - $24.15/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

Employee Benefits at United Health Services

When you work at United Health Services, you become part of our family. We’re proud to offer competitive benefits and compensation to our employees who make an impact every day.

• Health, dental, and vision insurance
• Voluntary benefits, including cancer, pet, and life insurance
• 403(b) retirement plan with company match model
• Immediate accrual of paid time off
• Wellness program rewards and insurance discounts
• Employee Assistant Program (EAP) counseling and concierge services
• Free, extensive online training through HealthStream

About United Health Services

United Health Services is a not-for-profit healthcare system serving more than 500,000 people in Upstate New York’s Southern Tier region. We offer integrated healthcare services across 60 locations, including four hospitals, three walk-in centers, and 22 primary care offices, in addition to home care services and senior living facilities. The United Health Services system employs more than 6,300 people and comprises 600+ providers who are all committed to providing and supporting the delivery of exceptional patient care.

United Health Services employees and providers are “LOVED!” This means we’re Living Our Values Every Day. Here, you’ll join a team that is dedicated to values-based, coordinated patient care. Every day, we outwardly live our Values of Compassion, Trust, Respect, Teamwork, and Innovation.

About New York’s Southern Tier

As an employee of United Health Services, you’ll call the Southern Tier, or more specifically, the Greater Binghamton area, home. Known for entertainment and restaurants, craft brews, outdoor experiences, minor-league sports, family-friendly events, and a keenness for local history (like our connection to the Twilight Zone and our six antique carousels), Greater Binghamton offers something for everyone. We’re a short drive away from the Finger Lakes region in Central New York, three hours from New York City, and just shy of four hours from Niagara Falls, Canada.

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United Health Services in an Equal Opportunity Employer.

United Health Services, Inc. and the members of the UHS System neither are affiliated with, sponsored, endorsed nor approved by, nor otherwise associated with, Universal Health Services, Inc. (NYSE: UHS), UHS of Delaware, Inc. nor their affiliates, which can be found at www.uhsinc.com.