Denial Management Specialist, Region A

HarmonyCares is one of the nation’s largest home-based primary care practices. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home. This includes HarmonyCares, HarmonyCares Medical Group, HarmonyCares Home Health, HarmonyCares Hospice and The Home DME.

Our Mission – “Through Compassionate Patient-Centered Care in the Home; We will Provide Exceptional Outcomes across our Continuum of Services”

Our Values – Respect, Integrity, Teamwork and Excellence - are leading us to a better tomorrow for patient care.

Why You Should Want to Work with Us

• Health, Dental, Vision, Disability & Life Insurance, and much more
• 401K Retirement Plan (with company match)
• Tuition, Professional License and Certification Reimbursement
• Paid Time Off, Holidays and Volunteer Time
• Paid Orientation and Training
• Day Time Hours (no holidays/weekends)
• Great Place to Work Certified
• Established in 11 states
• Largest home-based primary care practice in the US for over 28 years, making a huge impact in healthcare today!

Position Description

The Denial Management Specialist is responsible for the optimal payment of claims from Medicare, Medicaid, BCBS, Commercial and Manage Care Plans for Region B in assigned states. This includes consistent follow up on unpaid /denied claims, filing appeals when appropriate, and monitoring trend in denials of payment changes. As a Denial Management Specialist you will:

• Review Claims failed on Front End Edits due to various reasons; analyze the root cause by contacting Patients/ Payers / Inter Departments and Clearing House
• Worked with inter department and other parties involved for lack of information that may be causing up front payer rejections, correct and submit clean claims
• Review and analyze insurance claims with accounts receivable balances that have aged beyond 30 days old or claims denied in the Insurance Follow-Up Module, and A/R reports
• Accesses denied claims from the worklist and queries claim status with the payor, utilizing all appropriate systems, websites to effectively research the claim and resubmit or appeal as necessary
• Make necessary arrangements for medical records requests, completion of additional information requests etc. as requested by insurance companies to ensure timely resolution of outstanding denied/unpaid claims
• Prioritizes claims based on aging and outstanding dollar amounts, or as directed by management
• Regularly meet with supervisor to discuss challenges or billing obstacles as well as to provide status of outstanding ageing reports worked

Required Knowledge, Skills and Experience

• High School Diploma or Equivalent
• Minimum of 2 years of insurance follow up experience in a healthcare insurance environment and ability to multi task
• Computer experience is essential, including but not limited to: practice management software, word processing and spreadsheet applications, and 10-key by touch
• Knowledge of multi-specialty physician billing procedure guidelines according to Medicare, Medicaid, Commercial, and third party payer policies and basic understanding of medical terminology, ICD 9 and CPT 4
• Experience in filing claim appeals with different payers to ensure maximum entitled reimbursement
• Ability to perform mathematical computations
• Skill in defining problems, collecting data and interpreting billing information
• Additionally, the ability to work effectively with staff, patients, public and external agencies
• Good customer service and telephone techniques required as well as a high level of confidentiality

Preferred Knowledge, Skills and Experience

• Certification in Medical Billing/Coding
• Two years of related experience

Won’t you join us? We are seeking candidates who desire the opportunity and experience of delivering quality and compassionate healthcare - within proven care models – to elderly individuals and those with complex medical issues, who are the forefront of everything we do.