Job Opening

Denial Specialist

The Denial Specialist role focuses on working denied claims and resolving incomplete claims.  Focused efforts will be on any claim in the over 90 day bucket.

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Clinicient Culture

Are you looking for a fast-paced company where our people are our competitive advantage? A company that fosters your entrepreneurial spirit by encouraging you to act like an owner?  Do you have the passion and drive to push beyond the adequate to exceptional? Are you passionate about fixing the healthcare system?  Do the core values of Coach More, Shoot Less; Fail Fast, Succeed Faster; Deliver Exceptional Results; Find a Better Way; Be Honest and Transparent; and Enjoy the Journey inspire you?  If so, please apply for our open position.

At Clinicient we help physical therapy practices care with confidence and it feels good to know that what we do ultimately contributes to a patient’s well-being. We do it by coaching our customers to help them take control, simplify and thrive in their practices. You’ll be a part of the Clinicient Coaching staff helping therapists do what they do best—heal people.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Work payer claims either by aging date, or more likely by payer categories
  • Utilize all tools available to understand status of a claim at the 30 to 45 day mark depending on the payer; check websites, IVR systems, and phone calls to the payor as needed.
  • Recognize problem payers who receive claims on paper and evaluate the need to verify claim receipt at 30 days
  • Work claims as prioritized by the team based on knowledge of the client, their status with payers and knowledge of difficult payers for that client (WC, Medicaid, TPA’s, etc)
  • Communicate problems with payers to the Account Manager and determine if client involvement is needed in understanding their relationship to the payer
  • Identify denials or requests for more information to support the claim, documentation for medical necessity or functional status, etc.  Resolve if simple and can be done in 30 min or less
  • Have prior knowledge of medical necessity and LCD’s (local coverage determinations) and attain new knowledge regarding the claim process
  • Keep claim regulation knowledge up to date
  • Be comfortable with working on multiple projects simultaneously
  • Recognizes, analyzes and reports on data related to underpayments, denials, revenue opportunities and revenue leakage
  • Responds to client tasks in regard to AR or patient accounts
  • Answers phone calls from clients and patients in regard to AR and patient statements

SECONDARY DUTIES AND RESPONSIBILITIES

  • May be asked to assist with denials or coordinate efforts with the Denial Specialist
  • Be very inquisitive in regards to the intentions of the client and insurance company
  • Be passionate and assertive in problem solving

EXPERIENCE AND EDUCATION

  • Bachelor’s degree preferred
  • 1 to 2 years’ experience in insurance, healthcare or medical billing

SKILLS AND ABILITIES

  • Must be a role model of Clinicient’s Core Values: Be Honest and Transparent; Coach More, Shoot Less; Deliver Exceptional Results; Enjoy the Journey; Fail Fast, Succeed Faster; and Find a Better Way.
  • Experience in managed care contracts, reconciling patient accounts, and balancing payment transactions against contract rates and terms is strongly desired
  • Keen attention to detail with ability to spot trends and proactively reduce denials
  • Medical billing knowledge
  • Critical thinker with demonstrated ability to perform root cause analysis, problem solve, prepare and implement action plans and lead improvement initiatives
  • Strong oral and written communication skills
  • Proficiency in the use of PCs and MS Office suite
  • Ability to adapt to a changing and dynamic environment
  • Comfortable working in both individual and team settings
  • Ability to interpret and implement regulatory standards

Work Environment

Clinicient offers a competitive benefits package with fully-paid medical benefits, $100 monthly transportation reimbursement, monthly All-Hands meetings, company hosted happy hours and special events. Our offices are located in the heart of downtown Portland, Oregon, close to Pioneer Square, Food Carts and TriMet bus and MAX stops.

This position is performed primarily in an office environment. Significant portions of the job require extended sedentary periods, constant work with computers (including extended period of keyboarding), and repetitive motion of hands and wrists. Some limited travel to client locations may be required.

Clinicient is an equal opportunity employer and promotes a drug-free workplace.

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