Job Description
Denial Resolution Specialist II
REMOTE
Lakeland, Florida, United States
Denials – ADV
Full time
Description
What is Aspirion?
Aspirion Health Resources is an industry-leading provider of complex claims management services. We specialize in Motor Vehicle Accidents, Worker’s Compensation, Veterans Administration and Tricare, Complex Denials, Out-of-State Medicaid, and Eligibility and Enrollment Services. Our employees work in an environment that is both challenging and rewarding. We ask a lot out of our team members and in return we offer flexibility, autonomy, and endless opportunities for advancement. As we are committed to growth within the complex claims industry, we offer the same growth to our employees.
What do we need?
We are seeking experienced Denial Resolutions Specialists II for our growing healthcare revenue recovery company. Working on behalf of medical providers, you will be responsible for working with insurance companies for prompt resolution and correct payment of medical claims. Our team investigates and analyzes accounts to properly identify and coordinate insurance benefits and resolve outstanding balances. This is achieved by persuasively arguing through verbal and written appeals that payment should be made to the provider.
Responsibilities
- Efficient time management shills to be able to meet set goals and priorities.
- Review and analyze documentation including but not limited to client system, payor portals, clinical summaries, provider notes or explanations of benefits (EOB) to obtain knowledge and understanding of account history, past actions, patient treatment course, and current status of claim/denial.
- Review denied claims to determine appropriate action to resolve issues as assigned.
- Communicate via telephone with various insurance carriers to resolve claims issues as needed based on company protocol.
- Investigate and ensure that questions and requests for information are responded to in a timely and professional manner resulting in the accurate resolution of assigned accounts.
- Efficiently and legibly document account information into Aspirion’s Health Information System and/or the client(s) Patient Accounting System using Aspirion’s established account noting criteria to ensure the maximization of collection dollars.
- Consistently and properly update all required fields in the Aspirion Health Information System including but not limited to issue types, root cause, deadline dates, claim number and appeal numbers.
- Generate appeals, including online reconsiderations, based on the dispute reason and contract terms specific to the payor according to Aspirion protocol and program type.
- Request Bill correction and re-submission when appropriate.
- Follow specific payer guidelines for appeals submission
- Work special projects as needed.
- Work collaboratively and effectively with all other departments and functions to maximize operational efficiency and ensure accuracy and consistency in addressing denial issues.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Work Environment
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
Position Type/Expected Hours of Work
This is a non-exempt, hourly position: Monday through Friday, typically 8:00 a.m. to 5 p.m., but from time to time may require additional hours to successfully perform essential and secondary responsibilities.
Travel
No business-related travel is anticipated for this position
AAP/EEO Statement
Equal Opportunity Employer/Drug-Free Workplace: Aspirion is an Equal Employment Opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, pregnancy, religion, national origin, ancestry, medical condition, marital status, gender identity citizenship status, veteran status, disability or veteran status. Aspirion has a Drug-Free Workplace Policy in effect that is strictly adhered to.
Requirements
- Must have a minimum of 6 months of DRS1 experience within Aspirion, or a minimum of 1 year of revenue cycle/denial management experience, with an understanding of hospital billing, revenue cycle, appeals and collections guidelines and processes.
- Understanding of medical terminology, insurance plan types. interpreting medical records, EOB’s, and standard health industry claim billing forms.
- Basic understanding of ICD-10, HCPCS/CPT coding.
- Understanding of claims processing, payer denials, and appeal process.
- Excellent written skills to include correct use of spelling, grammar, and punctuation as well as strong professional verbal communication skills.
- Maintains strict confidentiality regarding Patient Health Information (PHI) as well as follows HIPAA regulations.
- Customer service experience.
- Ability to work independently as well as in a team environment to achieve business goals.
- Intermediate proficiency in computer skills using Office 365 Suite (Microsoft Word, Excel, Outlook software)
Benefits
At Aspirion we invest in our employees by offering unlimited opportunities for advancement, a full benefits package, including health, dental, vision and life insurance, matching 401k, competitive salaries and incentive programs.