Fresenius Medical Care North America Denials Management Specialist in Plano, Texas

PURPOSE AND SCOPE:

Ensure timely receipt of claim payments and minimization of unexpected bad debt by monitoring assigned denial work list, working with the appropriate clinical, regional and divisional staff to resolve any issues. Performs Accounts Receivable collection duties as assigned by Denials Supervisor, ensuring collection of past due balances to maintain profitability. Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the Fresenius Kidney Care (FKC) Compliance Program, including following all regulatory and FKC policy requirements.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Monitors all work lists specific to the Denials Management Specialist Role.

  • Ensures escalation of any work listed items requiring collaboration with other FKC partners. Examples: Managed Care, Master File Team, Coding, Non-Contracted, MFD

  • Performs the following duties as required based on denial/underpayment activity:

  • Identifies need for insurance changes and completes request for reverification process utilizing RIC coded comment.

  • Initiates re-bill of unpaid or underpaid claims.

  • Initiates appeal/reconsideration requests per payer guidelines.

  • Transfer balance where applicable to correct responsible party.

  • Process non cash related adjustments per established policy and procedure.

  • Identifies and communicates improvement opportunities to denial management leadership to ensure timely and accurate payment.

  • Ensure levels of follow-up are completed within established payer filing limits.

  • Researches and identifies complex claims issues and discrepancies and escalates to supervisor for resolution as needed.

  • Completes and documents all follow-up activities in eCube Financials per established guidelines.

  • Assist with various projects as assigned by direct supervisor.

  • Other duties as assigned.

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKING CONDITIONS :

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION :

High School Diploma required

EXPERIENCE AND REQUIRED SKILLS:

  • 3 years healthcare billing or collections experience.

  • Working knowledge of Windows-based software applications (i.e., Word, Excel)

  • Excellent written and verbal communications skills.

  • Good interpersonal skills and team oriented.

  • Ability to work independently.

  • Well organized and detail oriented.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity