Denials Specialist

Partnering With Physicians To Provide Best In Class Patient Care

Founded in 2002, Integrated Oncology Network is committed to helping our physicians deliver the right care, at the right time and in the right setting. We strongly believe that preserving the independent practice of medicine where patients are cared for closer to home and surrounded by our dedicated clinicians yields better outcomes. By creating a care continuum between our clinicians, patients and their support networks we deliver an unparalleled approach to the patient’s care journey.

Job Purpose: The Denials Specialist generates revenue by monitoring and pursuing payment on all unpaid and delinquent denied claims; serving as a liaison between the Provider, Payors, and Patient with regards to payment collections; and maintaining daily and monthly productivity goals to maximize cash flow.  

Essential Functions:

• Work all Verification or Benefit and Authorization denied claims received by payers.

• Responsible for verifying patient benefit eligibility including private, government and third party insurance information to ensure coverage of dates of service being worked.

• Coordination with authorization team when and if an authorization is needed
• Able to research denied CPT codes with comparison to the LCD/NCD requirements
• Effectively identifies trends that inhibit timely claim submission and payment
• Work average of 30-50 denials per day based on supervisor requirements and accounts assigned
• Works closely with insurance carriers for reimbursement requirements to ensure payment
• Provides clear and accurate documentation of all contacts or action completed with any internal or external persons concerning patient accounts
• Quickly becomes familiar with duties and performs them independently, accurately, efficiently, promptly, recognizing their importance and relationship to patient care
• Initiate and complete appeals for disputed / denied claims.
• Works / Understands electronic claim interchange
• Understands life cycle of primary and secondary claims
• Maintains a positive front office support relationship
• Takes incoming calls from insurance carriers and patients
• Regular attendance and punctuality.
• Contributes to team effort by accomplishing related results as needed.
• Ensures that all processing and reporting deadlines are consistently achieved.
• Perform any other functions as required by management.

Qualifications and Education Requirements

• Minimum 2 years experience in Insurance follow-up
• Understanding of managed care contracts and fee schedules, including Medicare and Medicaid
• Experience with computerized billing software and interpreting EOBs
• Working knowledge of ICD-9/ICD-10, CPT, HCPCS, and CPT coding

Preferred Skills

• Knowledge of medical terminology
• Familiar with Chemotherapy and Radiation Billing

Required Competencies

Ability to work in a team environment and be able to multi task. Strong Business and Organizational Competence.  Exceptional Customer Service Skills.  Strong functional Competence. Interpersonal Skill Competency. Stress Tolerance. Initiative. Adaptability. Accountability. Integrity. Self-Confidence. Time Management Skills with an emphasis on multi-tasking. Ability to maintain a professional, polished image. Ability to communicate effectively, both written and verbal.

Physical Demands and work environment

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical demands: Required job duties are essentially sedentary in nature, consisting of occasional walking, standing, lifting and/or carrying twenty five pounds maximum, seeing, speaking and hearing. Must be able to lift up to 25 pounds.

Work environment:  Required job duties are normally performed in a climate-controlled office environment.