Denial Management Specialist

Job DescriptionDivision/Department: Human Services - Revenue Cycle Location: Min No Aya Win Human Services Center - Onsite Reports To: Billing/Accounts Receivable Manager Probationary Period: 90 days - Full time, 120 days - Part time FLSA Status: Non-Exempt (Hourly) Classification: Non-Child-Related NA Driver's License: Level 0 - No Driver's License required. Rate of Pay: $22.34 to $25.13 Responsibilities Maintain a working knowledge of health care plan requirements and health plan networks . Ensure professional communication with patients, clinic personnel, and outside vendors over the phone, via email or other written documentation and respond to all inquiries. Review Explanation of Benefits (EOB), research denials, rejections and/or excessive reductions. Prepare, submit and ensure timely claim accuracy for all physician billing to third party insurance carriers either electronically or via hard copy. Make outbound phone calls to patients or insurance companies as follow up to unpaid, denied or rejected billing claims and document according to current policy. Share this information with other Patient Account Reps and providers if necessary. Print letters on letterhead to patients when insurance company is requesting information from the patient. Follow up with a phone call to the patient as necessary. Review and mail patient statements on a weekly basis according to policy. Process past due accounts as directed in policy. Validate services provided under patient account for matching dates of services as well as ICD-9-CM/ICD-10 coding to the highest specificity available. Follow up on all accounts as necessary such as open visits that are older than 30 days and payroll deductions, etc. Attend meetings with providers and support staff as requested. Keep abreast of coding guidelines and reimbursement reporting requirements. Brings identified concerns to the department manager for resolution. Process daily mail. Appropriate work attire is required. Must attend all mandatory department trainings. Ensures confidentiality of financial records and all records for employees, band members and/or clients. Displays a responsive and professional manner in promptly responding to all requests, complaints, and problems. Recognizes that each employee is a representative of the Fond du Lac Band of Lake Superior Chippewa and is responsible for demonstrating courtesy, respect, and sensitivity to the needs of all others, including visitors and co-workers. Represents the Fond du Lac Band of Lake Superior Chippewa and the department in a positive and professional manner in the community. Required to maintain proper attendance including reporting to work on time in accordance with applicable policies. Maintains a clean and organized work area. Due to changes and modifications in the job from time to time, employees are required to be flexible and assume other responsibilities assigned by management as deemed necessary. Qualifications No Driver's License required. High school diploma or G.E.D. is required, associate degree or higher preferred. 3+ years of billing medical services is required. Experience with EHR and billing systems (NextGen, Waystar, Residex, Dentrix) Knowledge of computer applications to include word processing, Access, Excel and Microsoft Outlook is required. Ability to communicate effectively orally and in writing is required. Ability to work independently and establish priorities is required. Attention to detail and accuracy is required. Ability to establish professional and harmonious working relationships on all projects and with all parties involved. Subject to drug and alcohol testing in accordance with the Fond du Lac Reservation's Personnel Policies. Subject to pre-employment and annual background checks. Subject to immunization review and submitted proof of required vaccinations. Travel is required. PHYSICAL REQUIREMENTS: Normal physical requirements. About Us The Fond du Lac Band of Lake Superior Chippewa, Nagaajiwanaang (Where the water stops), is one of the six Bands of the Minnesota Chippewa Tribe and a proud sovereign Ojibwe nation. We strive to be a diverse, supportive, and inclusive workforce that employs Fond du Lac Band members, native peoples, and those from our surrounding communities. As one of Carlton County's largest employers, the Fond du Lac Band is dedicated to elevating the community through a broad spectrum of programs and enterprises including our gaming facilities, tribal government, health services, and education that promotes our language, culture, and the preservation of our natural resources. The Fond du Lac Band is an employer that cultivates the growth of our employees and our programs; a place where you can develop your skills and gain experience that will positively impact the lives of those who call the Fond du Lac Band home. Our hiring practices follow tribal employment rights outlined in Fond du Lac Ordinance #12/94 (TERO). Join the Fond du Lac Band of Lake Superior Chippewa in our mission to preserve and promote our community while contributing to its vibrant future.

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