About Us
McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana. The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 53 National Cancer Institute-designated comprehensive cancer centers in the U.S.
Denials Management Specialist
Position Summary:
The denials management specialist is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The specialist will work independently while managing their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered.
Essential Functions and Responsibilities:
- Monitors denial work queues and reports in accordance with assignments from direct supervisor. Maintains required levels of productivity while managing tasks in work queues to ensure timeliness of follow-up and appeals.
- Tracks and investigates denial trends/ root cause
- Assists with claim audits as necessary
- Makes management aware of any issues or changes in the billing system, insurance carriers, and/or network.
- Obtain retro authorizations and submit to payers for reimbursement.
- Ability to write non-clinical appeals with demonstrating proficiency with timely and successful submissions.
- As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or CBS management.
- Works independently with other departments to resolve A/R and payer issues.
Qualifications
· Associate degree required.
· Minimum of 3 years in a hospital or physician billing office.
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
