Clinical Denial Specialist is under the supervision of the Director of Clinical Denial Management. This position is responsible for all insurance follow-up on assigned denial accounts from the Case Management Team. The core responsibilities are research, medical records review, insurance billing and adjustment identification to ensure proper account resolution.
KNOWLEDGE AND ABILITY
Registered Nurse in the State of WV.
Must have full understanding of insurance follow-up processes (i.e. Billing, Collections, Managed Care, Medicare, Medicaid, and Commercial Practices).
Strong interpersonal skills, excellent verbal, and written communication skills.
Knowledge of EOBs, CPT, ICD-9, ICD-10 codes, HCFAs, UB04s, HCPCS, DRGs and authorization/referrals
Strong computer skills, experience with Microsoft Excel and Word.
Good problem-solving skills.
EXPERIENCE
A minimum of two years’ previous work experience as an appeals nurse is required.
Must have a strong Customer Service background.
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Application Question(s):
- What are your wage requirements?
Education:
Experience:
- ICD-10: 1 year (Preferred)
- Appeals Nurse: 2 years (Required)
- EOB: 1 year (Required)
- HCFA: 1 year (Preferred)
- HCPCS: 1 year (Preferred)
- insurance follow-up: 1 year (Required)
License/Certification:
Ability to Relocate:
- Weirton, WV 26062: Relocate before starting work (Required)
Work Location: In person