We are hiring a skilled Denial Management Specialist in the area of Bakersfield, CA. You will ensures optimal performance in all areas of denial prevention and appeal processing. Responsible for monitoring state and federal regulatory agencies and payer information to maintain up-to-date knowledge on changing rules and regulations affecting Medical and Dental practice reimbursement. Correct and resubmit claims to reduce reimbursement delays. Assist management with assigned special projects which may include provider and staff training & education.

 

Job Duties:

• Follow up on denied claims from all commercial and contracted payers where denials can be associated with coding errors. Assign and sequence ICD-10-CM/ CPT-4 diagnostic and procedural codes review physician documentation & coding for appropriateness & accuracy make corrections following Medicare & AMA coding guidelines.
• Review and analyze medical records for accurate ICD & CPT selection and serve as the coding subject matter expert for the patient accounts denial management function.
• The denial management specialist thoroughly investigates denied claims to ensure timely and proper follow-up for addressing denials including assigning them to appropriate company providers as well as coordinating with the insurance claims representative and collection specialists/ charge posters to complete the research to support the claim review and to determine and execute the appropriate course of action for resubmission of the claims to obtain reimbursement in a timely manner.
• Perform timely and appropriate validation and follow up on denied claims, including initial assessment of the denials received via DSG EDI
• Identify and escalate coding trends that are impacting denial volume.
• Perform retrospective audits of new self-pay accounts to update demographic information.
• Resolves routine coding issues/ problems and initiates additional training as needed with staff and providers.

Additional Duties

• HIPAA compliance - Responsible for enforcing compliance with all HIPAA regulations and requirements. Treats all member information confidential.
• Compliance - Ensure compliance with all local, state, and federal regulations.
• QA/QI - Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
• IT - Required to learn and use the Electronic Health and Practice Electronic System and its components as required by the job functions and highlighted in the Policies and Procedures.
• All employees will participate in Patient Centered Home Health Models

 

Hiring Requirements: 

• Valid identification that proves your right to work in the United States 
• As a condition of employment, you may be required to pass a drug screen and background check 
• Call us today at 661-393-9700 to discuss your work experience 
• Register at www.exactstaff.com/register 

EXACT STAFF is an E-Verify employer. All offers of employment are conditioned upon presenting identification proving identity and the legal right to work in the U.S. Exact Staff is an equal opportunity employer. We are dedicated to ensuring that all decisions regarding terms, conditions and privileges of employment are in accordance with our principles of equal opportunity. We will not discriminate against employees or applicants on the basis of race, color, national origin, ancestry, religious creed or religious beliefs, age, sex, marital status, medical condition, pregnancy, childbirth or related medical condition, sexual orientation, gender identity or expression, physical disability, mental disability, citizenship, military status, protected genetic characteristics, or any other characteristic protected by state or federal law or local ordinance. We comply with the ADA and applicable state and local laws and consider reasonable accommodation measures that may be necessary for eligible applicants to perform essential functions of the job. Hire may be subject to passing a medical examination, skill and agility tests. LOS ANGELES APPLICANTS: Exact Staff will consider for employment qualified Applicants with Criminal Histories in a manner consistent with the requirements of Article 9 to Chapter XVIII of the Los Angeles Municipal Code