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Healthcare Insurance Denial Specialist

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Center for Diagnostic ImagingSt Louis Park, MN
  • RAYUS Radiology, formerly Center for Diagnostic Imaging and Insight Imaging, is looking for a Insurance Denials Specialist to join our team.
  • We are challenging the status quo by shining the light on radiology and making it a critical first step in diagnosis and proper treatment.
  • Come join us and shine brighter together!
  • JOB SUMMARY: As an Insurance Denials Specialist you will investigate and determine the reason for a denied or unpaid claim, and take necessary steps to expedite the medical billing and collections of the accounts receivable.
  • At CDI our passion for our patients, customers and purpose requires teamwork and dedication from all of our associates.
  • Working in a team environment, you'll communicate with patients, insurance carriers, co-workers, centers, markets, referral sources and attorneys in a timely, effective manner.
  • Creates a positive experience for every customer, every day by believing in and practicing The Experience
  • 85%) Insurance Denial Follow-up
  • Accurately and efficiently reviews denied claim information using the payer's explanation of benefits, website, and by making outbound phone calls to the payer's provider relations department for multiple denial types, payers, and/or states
  • Reviews and obtains appropriate information or documentation from claim re-submission for all denied services, per insurance guidelines and requirements
  • Communicates with patients, insurance carriers, co-workers, centers, markets, referral sources and attorneys in a timely, effective manner to expedite the billing and collection of accounts receivable
  • Documents all communications with coworkers, patients, and payer sources in the billing system
  • Contributes to the steady reduction of the days-sales-outstanding (DSO), increases monthly gross collections and increases percentage of collections
  • Prioritizes work load, concentrating on "priority" work which will enhance bottom line results and achievement of the most important objectives
  • Contributes to a team environment
  • Recognizes and communicates trends in workflow to departmental leaders
  • Meets or exceeds RCM Quality Assurance standards
  • Ensures timely follow-up and completion of all daily tasks and responsibilities
  • 10%) Staff Support
  • Assists in the mentoring and training of new Insurance Denials Specialists
  • Recommends and assists in implementing new approaches and ideas for improvement in processes and workflows
  • Serves as a resource for Insurance Denials Specialists
  • As assigned, acts as department go-to resource for team and others in Lead or Manager's absence
  • 10%) Performs other duties as assigned
  • As backup for customer service team, communicates and responds to customer inquiries as needed
  • Knowledge of and adherence to company policies and protocols
  • Knowledge of and adherence to HIPAA and safety guidelines
  • Knowledge of third party payors
  • Skill in organizing and prioritizing work and following assignments through to completion
  • Skill in written and verbal communication
  • Ability to work independently and in a team environment
  • Ability to work in a fast-paced environment and meet established deadlines
  • Ability to be flexible in schedule and adaptable to constant change
  • Ability to effectively handle details with accuracy
  • Ability to maintain regular attendance and on-time arrival to work as scheduled
  • Ability to deliver high quality customer service to internal and external customers by communicating with integrity and compassion
  • Ability to resolve service recovery issues and understand when to escalate to the next level
  • Ability to convey complex subject matter clearly
  • Ability to remain calm in difficult situations
  • Ability to negotiate payment arrangements with patients, attorneys and insurance companies
  • Ability to interpret third party remittance advice
  • Ability to successfully submit third party appeals
  • High School diploma or equivalent
  • 4+ years' experience in a medical billing department, prior authorization department or payer claim processing department, or 2+ years' experience as Insurance Denials Specialist within the organization
  • Intermediate proficiency with Microsoft Excel, PowerPoint, Word, and Outlook
  • Proficient with using computer systems and typing
  • Graduate of an accredited medical billing program
  • Bachelor's degree strongly preferred
  • Knowledge of ICD-10, CPT and HCPCS codes
  • Requires use of office equipment, such as computers, fax machines, telephones and copiers
  • Requires computer-related activities for extended periods of time
  • Requires the ability to see, hear, speak, write, and key
  • May require some lifting, bending and stooping
  • RAYUS is committed to delivering clinical excellence in communities across the U.S., driven by our passion for and superior service to referring providers and patients.
  • RAYUS Radiology is built on our brilliant medicine, brilliant team, brilliant technology and services
  • all to provide the highest level of patient care possible.
  • We bring brilliance to health and wellness.
  • Join our team and shine the light on Radiology Services!
  • RAYUS Radiology is an EO Employer/Vets/Disabled.
  • St. Louis ParkMinnesota

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