DME Denials/Appeals Specialist x3

Prestige Staffing has been tasked by one of our best clients to find Medical Insurance Denials/Appeals Representative to interview and go to work ASAP! Candidate must be hard working and a self-starter. If you want the opportunity to work in a rewarding and dynamic environment, this is your chance. This is a temp to perm position.

Pay: $18-20/hr

Location: Onsite, Miramar, FL

JOB RESPONSIBILTIES:

• Identify, review and resolve denials manually and/or electronically by using the designated information technology on a timely basis. Reviews EOBs and remittance reports for denials, errors and resubmits claims with correct data
• Confirm denial reasons.
• Generate an appeal based on the dispute reason and contract terms specific to the payors
• Follow specific payor guidelines and medical policies for appeal submissions
• Escalate exhausted appeal efforts to the appropriate parties 
• Research and analyze denial data and coordinate denial recovery responsibilities
• Review patient medical records and utilize regulatory and payor knowledge to Identify, analyze, and research frequent root causes of denials and develops corrective action plans for resolution
• Document all account activity on each account through descriptive account notes in employer’s system
• Request documentation from clients as required to resolve accounts
• Adhere to all policies and procedures

QUALIFICATIONS:

• High School Diploma.
• Three (3) years job related experience in Business Office or Central Business Office (CBO).
• Working experience with medical terminology and claim denials / underpayments
• Proficiency in Microsoft Office products (e.g. Word and Excel)
• Demonstrates understanding of medical terminology
• Knowledge of CPT, HCPCS, ICD-10 coding procedures
• Good communications skills, both written and oral
• Knowledge of medical billing and collection practices
• In-depth working knowledge of Commercial, Managed Care and Government insurance carriers