Denial Resolution Specialist II

This role is responsible for reviewing, analyzing, and initiating appropriate action for complex denial resolution by communicating with payers, hospital departments, and patients. It is a non-exempt, full-time position within the Denials cost center at UMass Memorial Health in Worcester, MA.

What You Will Do

Triages denial root cause and executes appropriate next steps, identifies trends, and participates in interdepartmental resolution strategies. Researches complex denials, resolves accounts with high dollar balances, and submits appeals following payer procedures. Documents all actions taken during the denial resolution process.

Why It Might Be a Fit

Candidates should have four or more years of experience in health care billing functions and a proven track record of successful performance. The role requires advanced knowledge of claim form content and claim submission requirements, as well as experience with high-dollar, high-complexity claim submissions. The position offers a hiring range of $20.94 - $29.27 per hour and may include a signing bonus.

Requirements

• Four or more years of experience in health care billing functions
• Previous health care billing experience
• Proven track record of successful performance and goal achievement
• Experience in denial resolution process
• Advanced knowledge of claim form content and claim submission requirements
• Understands and can explain the purpose of revenue codes, condition codes, occurrence codes, modifiers and value codes
• Proactively proposes resolutions to issues
• Ability to communicate verbally and clearly document all actions taken during resolution process
• Demonstrates ability to research denial issues
• Can provide root cause of denial issue and identify next steps needed to resolve issue
• Ability to navigate in MassHealth claims processing application and/or the Medicare claims processing application
• Experience with high dollar- high complexity claim submissions, i.e. Long length of stay, coverage changes and lapse, coordination of benefit issues
• Ability to work collaboratively and effectively with people
• Exceptional communication and interpersonal skills

Benefits

• Signing bonus (eligibility confirmed during interview process)