Denial Management Specialist

Job not on LinkedIn

🕒 June 25

🏄 California – Remote

🏄 California – Remote

💵 $22 - $24 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 18%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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VitalConnect

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2011

🏭 Manufacturing

🏥 Healthcare

📡 Telecommunications

Manufacturing • Healthcare • Telecommunications

VitalConnect is a healthcare technology company that specializes in remote patient monitoring solutions, particularly for cardiac health. Their flagship product, the VitalPatch RTM, enables real-time streaming of vital signs, allowing healthcare providers to monitor patients' conditions from the comfort of their homes. VitalConnect is especially relevant in the context of COVID-19, as their technologies facilitate the safe monitoring of patients while minimizing caregiver exposure. The company's innovative approach in telehealth has made it a key player in optimizing patient care.

📋 Description

• Investigate and resolve complex third-party insurance denials and outstanding claims. • Conduct comprehensive research and review of payer denials related to referrals, pre-authorizations, notifications, medical necessity, non-covered services and billing. • Determine whether authorization, a written appeal or no action is needed. • Write and submit detailed appeals based on clinical documentation, third-party medical policies and contract language. • Customize appeals according to Medicare, Medicaid, third-party payer guidelines and VitalConnect policies and procedures. • Select and submit relevant clinical information to support appeals. • Contact payers through websites, payer portals, phone and correspondence regarding claim reimbursement. • Track and trend recovery efforts and report payer- or contract-specific issues. • Ensure eligible accounts are appealed within payer time frames and documented in the patient software system. • Identify and track root causes, appeal denied accounts and trend issues while meeting productivity standards. • Cross-train and function in all department areas related to accounts receivable and denials. • Escalate financially uncleared accounts to management according to department policy. • Perform follow-up activities from management reports and review daily payer correspondence. • Maintain confidentiality of patient financial and medical records and promptly advise management of compliance issues. • Communicate effectively and courteously with internal and external customers. • Perform other related duties as assigned or required.

🎯 Requirements

• A bachelor’s degree or equivalent work experience is required. • 3+ years of experience in a medical collections setting with experience in denials, appeals, insurance collections and related follow-up. • Strong knowledge of healthcare terminology and CPT-ICD10 codes. • Complete understanding of insurance, including insurance plans, coordination of benefits, explanation of benefits, coverage and utilization guidelines. • Demonstrated customer service skills and ability to use appropriate judgment, independent thinking and creativity when resolving customer issues. • Exceptional interpersonal skills and ability to establish and maintain effective relationships with patients, physicians, management, staff and other customers. • Ability to communicate effectively in writing. • Comfortable with ambiguity; good decision-making and judgment capabilities; attention to detail. • Ability to maintain strict confidentiality of personal/health-sensitive information. • Ability to handle challenging situations and balance multiple priorities. • Basic computer proficiency, including accessing, entering and interpreting computerized data/information. • Proficiency in Microsoft Suite applications, specifically Excel and Word. • Deep understanding of Revenue Cycle processes and ability to meet and maintain productivity standards. • Ability to work with payer portals such as Navinet and Availity. • Knowledge of Medicare, Medicaid, contracted, in-network, out-of-network and commercial payer billing requirements. • Knowledge of EOBs, remittance and remark codes, denial remark codes and timely filing guidelines. • Ability to maintain patient confidentiality and comply with HIPAA and applicable state and federal healthcare collection laws.

🏖️ Benefits

• Medical benefits • Dental benefits • 401K retirement plan