Denials Recovery Specialist I
Req #: 44962
Full Time
Shift: Days
Denials Recovery
United Health Services Hospitals
Binghamton, NY
Weekly hours: 40

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
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Benefits That Make A Difference

While you’re making a difference in the health and well-being of our patients and communities, United Health Services takes care of you. We are proud to be able to offer our employees and providers a comprehensive benefits package that supports their needs today and for the future with a competitive retirement plan; comprehensive health, dental, vision and health savings and spending accounts; wellness programs that empower our employees to stay healthy and balance work and life goals; group life and disability options; and a generous paid time off (PTO) program. On top of that, we invest in you by offering tuition reimbursement and other programs designed to help you grow your career. The majority of these benefits are available to you for working at least 24 hours per week.

These are just a few of the perks and benefits you can expect when you join the United Health Services team. Be sure to ask your recruiter about all the benefits associated with the position you’re applying for.

Why United Health Services?

We are one of the region’s top employers with an excellent reputation for the care we provide. Our pay, benefits and perks are very competitive. We’re compassionate about patients and respectful of each other. We offer you the stability, size, scope and capabilities of big city health systems, but with the trust and familiarity of more personalized care. We’re engaged with our communities. And, we recognize the importance of work-life balance. Discover the difference you can make, here with us, at United Health Services.

About Our Region

Binghamton, a friendly and close-knit city in Broome County, offers beautiful and affordable homes in downtown, suburban and rural settings, as well as good public and private schools. Nightlife and cultural activities include craft breweries, restaurants and award-winning wineries. First Fridays celebrate local artists and there are frequent music and food festivals. Outdoor activities also abound, from skiing and golf to hiking, biking and more.