Denials Specialist
Manage technical claim denials and follow-up components across healthcare organizations.
Company Overview
Helix Advisory is a leading healthcare consulting firm specializing in revenue cycle management and optimization. We work with healthcare organizations to enhance their financial performance by identifying underpayments, optimizing clinical documentation, and managing appeals processes.
Our team is dedicated to delivering exceptional results and driving innovation in healthcare finance.
Position Summary
The Denials Specialist is responsible for technical claim denials and follow-up components across Helix Advisory clients. Job duties include, but are not limited to, contacting insurance plans to determine reasons claims were denied, analyzing the claims and determining the appropriate next steps, including referring to clinical appeal, sending for coding review, submitting reconsiderations, flagging for rebill with appropriate reasoning, and preparing the appeal materials.
Essential Job Functions
- Contacting insurance plans to determine reasons claims were denied
- Analyzing the claims and determining appropriate next steps, including if appeal is necessary
- Preparing the appeal materials into submission packets, which may include gathering additional information, reviews of medical records, and making arguments for overturn
- Acting as a liaison between healthcare providers for any additional medical documentation or clarification and submitting appeals in a timely manner
- Work closely with the coding, appeals nurses, and billing departments to ensure denials are worked, outcomes tracked, and resolution occurs in a timely manner
- Follow-up with insurers and other payors on status of submitted denials
- Performs other duties as assigned
Qualifications
Job Experience
- 1 to 3 Years
Education Level
- Associate's degree or Equivalent Experience
Knowledge, Skills and Abilities
- Preferred Minimum Education – Associate's Degree, Specialty/Major: business, finance, or relevant discipline; HFMA Certified Revenue Cycle Representative or similar certifications
- Minimum Years and Type of Experience: 2 years of denials, utilization review, or other revenue cycle experience strongly preferred
- Type 35 wpm
- Experience in hospital operations, chart audit/review, and provider relations
- Strong analytical reasoning and research skills
- Strong verbal and written communication skills
Why Join Helix Advisory?
- Impactful Work: Play a crucial role in ensuring healthcare providers receive proper reimbursement
- Professional Development: Opportunities for growth and advancement in a dynamic and supportive environment
- Collaborative Team: Work with a talented team of professionals committed to excellence and innovation
- Competitive Compensation: Attractive salary and benefits package