Medical Claims Denial & Appeals Specialist

University of Colorado Medicine ( CU Medicine ) is the region’s largest and most comprehensive multi-specialty physician group practice. The CU Medicine team delivers business operations, revenue cycle and administrative services to support the patients of over 4,000 University of Colorado School of Medicine physicians and advanced practice providers. These providers bring their unparalleled expertise at the forefront of medicine to deliver trusted, compassionate health care services at primary and specialty care clinics as well as facilities operated by affiliate hospitals of the University of Colorado. We are seeking a highly motivated Medical Claims Denial & Appeals Specialist to join our Accounts Receivable Resolution team. This job can be performed 100% remotely and out of state candidates will be considered. The Specialist is primarily responsible for resolving all insurance claim denials for assigned departments to enhance revenues for CU Medicine providers. The individual in this position will generate effective written appeals to carriers using well-researched logic. Denial Specialists are independently accountable for the denial resolution for their assigned divisions. Duties and responsibilities include but are not limited to the following:

Appeal denials through coding review, contract review, medical record review and carrier interaction. Demonstrate a high level of expertise in the management of complicated denied claims. Deploy analytical approach to resolve denials and recognize trends/patterns in order to proactively resolve recurring issues. Utilize a multitude of resources to ensure correct appeal processes are followed. Communicate identified denial patterns to management. Prioritize and process large volume of denials and maintain high quality of work. Serve as an escalation point for unresolved denial issues. Inform team members of payer policy changes. Assist in training new employees as assigned. Collaborate on special projects as needed.

Originally posted on Himalayas