Denial Management Specialist

🔥 0 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $75k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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LEARN Behavioral

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

📚 Education

Healthcare Insurance • Education

LEARN Behavioral is a specialized provider of contemporary, family-focused applied behavior analysis (ABA) therapy for children with autism spectrum disorder (ASD) and other special needs. With over 20 years of experience, LEARN Behavioral tailors treatment programs to develop language, communication, social, play skills, and more, while decreasing behaviors that interfere with learning. The company supports children in various settings, including home, community, school, and centers, also offering telehealth services. LEARN Behavioral is dedicated to fostering resilience and fulfillment in children and collaborates with districts and schools through LEARN Academy to provide expert autism services and educational support.

📋 Description

• Investigate, resolve, and appeal denied or underpaid insurance claims. • Analyze denial trends and payer behavior. • Maintain accurate documentation and follow-up activities. • Partner with Revenue Cycle, Utilization Management, Credentialing, Clinical, and Operations teams. • Monitor assigned denial work queues and productivity metrics. • Assist the RCM Department in leadership coaching, oversight, support, and training for Revenue Cycle Management team members. • Work closely with payers and operation leads to troubleshoot and resolve claims. • Continuously provide improvements to systems and processes along with support to team members within the RCM Department. • Effectively communicate with our payors’ partners and Operation Leads. • Navigate claims appeals and special projects with payors. • Review all unbilled claims and outstanding A/R. • Prioritize meeting department deadlines. • Process audit requests timely and accurately. • Take the lead on monitoring assigned projects to completion.

🎯 Requirements

• High School diploma required; Bachelor’s Degree in Finance, Accounting, Healthcare Administration, or related field preferred. • 5+ years in revenue cycle management, with at least 1 year in a supervisory or team lead role required. • Experience in Billing Software, Clearinghouse, Payor Portals, and Excel required. • Strong analytical and strategic thinking skills. • Excellent communication and interpersonal skills. • Ability to identify complex problems and develop and evaluate options to implement solutions. • Demonstrated ability to work independently and as part of a team in a fast-paced, dynamic environment. • Strong organizational skills and attention to detail, with the ability to manage multiple priorities and deadlines effectively.

🏖️ Benefits

• 401(k) • personal time off • paid holidays • tuition reimbursement