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About the Role

The Denials Management Clerk supports the Denial Management Department in the denials process for client hospitals by gathering and disseminating information from hospitals, physicians, and insurance companies pertaining to referred claims denied.

Responsibilities

• Manually enter new cases referred from clients into database as needed
• Update database with information gathered from correspondence
• Set follow-up reminders in Outlook
• Review daily reports for updates and due dates
• Send updates on document requests received throughout the day
• Send documentation to insurance carriers via portals, email, mail or fax
• Work within gAIge to update daily tasks assigned on work queue
• Log into all hospital applications and insurance carrier portals every two weeks
• Submit appeals, correspondence, and medical records via carrier portals
• Scan and label correspondence received daily via mail, email, or fax
• Navigate hospital applications to obtain balances, charges, and UB documents
• Download reports from portals for updates
• Assist with the outgoing mail process
• Scan documents into database
• Assist patients with questions related to statuses of their accounts
• Other duties as assigned
• Use, protect, and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Requirements

• Must be courteous and possess a strong work ethic, with the ability to work in a fast-paced environment
• Ability to learn proprietary databases and systems, gAIge, Epic, Eagle, Epremis, Medi-Tech
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
• While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• The employee must be able to follow directions, collaborate with others, and handle stress.

Skills

• Proficient in Microsoft Office applications
• Strong organization and time-management skills
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• Excellent written and verbal communication skills required

Education Level

• High School Diploma or equivalent

About the Company

• Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Equal Opportunity

• Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.