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Denials Management Representative
Date Posted: 03/13/2024
Job #: 2990681
Location: Denver
Position Summary
The Denials Management Representative performs a wide range of duties
involving the resolution of claims denied or delayed processing by insurance
carriers. Identifies, monitors and resolves issues resulting in the denial
of claims. Takes corrective action to facilitate the re-billing and/or
appeal of claims and the subsequent reimbursement of originally denied claims.
Identifies, analyzes, and researches frequent root causes of denials and
assists management in developing corrective action plans to prevent future
deni
Essential Duties
Generates appeals based on the denial reason and contract terms of the payors.
This includes online provider disputes and reconsiderations. Follows specific
payor guidelines for appeals submissions, paying close attention to the
timelines for appeals. Escalate exhausted appeal efforts for resolution.
Works closely with managed care organizations, third party payors,
government payors and internal staff to ensure compliance to contract
requirements and/or state/federal regulations in order to expedite
reimbursement of claims and protect National Jewish Health (NJH) from
unnecessary financial loss.
Thorough and consistent follow up on unpaid /denied claims by utilizing
monthly aging reports, worklists and queries, claim status with the
payor, utilizing all systems, websites and tools available to effectively
research claims and resubmit or appeal as necessary.
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