Denials Resolution Specialist

Are you looking for the best place to work?  Join Addiction Recovery Care, LLC (ARC) which was selected as one of the 2024 Best Places to Work in Kentucky by the Kentucky Chamber of Commerce, based on surveys of our employees!

Are you passionate about serving in an environment of shared purpose and shared goals while driving the ARC mission and values to excellence for our clients, patients, and team members?  ARC has been leading the way and has become one of the fastest-growing healthcare systems in Kentucky (and beyond!) in addiction treatment, mental health services, and improving lives by creating opportunities for people to discover hope and live their God-given destiny!

ARC is ready to offer you “The B.E.S.T. of ARC” (Balance, Energy, Safety, Training) on day 1 when you enter through our doors.  ARC is a thriving, dynamic, and fast-paced healthcare system environment where compassion, accountability, respect for the dignity of life, entrepreneurship,  and stewardship are key elements of everything we do!

We are hiring a Denials Resolution Specialist to our growing team!  Under direct supervision the Denials Resolution Specialist is responsible for resolving outstanding claims with government and commercial health insurance payers submitted on behalf of Addiction Recovery Care in accordance with established standards, guidelines and requirements.  

Key Responsibilities

• Conducts root cause analysis of all assigned insurance payer claims and denials to determine appropriate actions required to resolve the claim / denial into a paid status.
• Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
• Builds relationships with MCO.
• Corrects identified billing errors and resubmits claims with necessary information through paper or electronic methods.
• Anticipates potential areas of concern within the claim’s denial function; identify issues/trends and provides feedback to Manager / Corporate Director Revenue Cycle.
• Recognizes when additional assistance is needed to resolve claim denials and escalates appropriately and timely through defined communication and escalation channels.
• Carry out insurance appeals
• Resolves work assigned according to the prescribed priority and/or per the direction of the Manager and in accordance with policies, procedures and other job aides.
• Assists with unusual, complex or escalated issues as necessary.
• Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc.
• Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
• Identifies potential trends in denials/reimbursement by payer or by type, denial reason, or coding issue and reports to supervisory staff for appropriate escalation.
• Uses critical thinking skills and payer knowledge to recommend system edits to reduce denials and result in prompt and accurate payment.
• Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding.
• Communicates with Manager and staff regarding insurance carrier contractual and regulatory requirements that impact payment and denials.
• Meets quality assurance and productivity standards for timely and accurate claim / denial resolution in accordance with organizational policies and procedures.
• Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function. Understands detailed billing requirements, denial reason codes, and insurance follow-up practices.
• Understands government and commercial insurance reimbursement terms, contract language, and appropriate reimbursement amounts.