Denial Technician (Clerical Support)

Summary: The Denial Technician provides clerical support to the SSC Appeal
Team. This individual is responsible for
reviewing new appeal requests, preparing folders, and providing all documents
to the Team so that everything is available for triage and appeal. Essential
Duties and Responsibilities: Manages workflow for all incoming
denial/appeal letters & audit correspondence via centralized email and
isynergy folders. Prepares folders, initiates appeal forms, and
compiles all documents required for triage and appeal. Accurately vets accounts; meets or exceeds
quality & quantity benchmark targets as established (productivity/PDFU) Directs ClaimIQ/Artiva requests to
appropriate parties for appeal review & validation. Accurately enters data into logs, DAR/Artiva,
or other programs. Submits requests for medical records, ub's,
and itemized bills as needed. Provide clerical assistance to the Denial
Management Team by assisting with correspondence, appeal letters, maintaining
software libraries and mailing and tracking their receipt. Ability to perform all other duties as
assigned or requested. Qualifications: Communication - communicate clearly and concisely, verbally and in writing; utilize appropriate method/tool to communicate with other departments as necessary Interpersonal skills - able to work effectively with other employees and external parties Policies & Procedures - demonstrate knowledge and understanding of organizational policies, procedures and systems; ensure confidentiality of all patient accounts by following HIPAA guidelines Performance - maintain performance standards that ensure the department is operating at peak proficiency and that established goals are consistently being met Time management and organization - perform work under tight guidelines, must be detail oriented and well organized. Ability to prioritize and control workload. Demonstrated critical thinking, creativity, problem solving and decision-making skills Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Computer Skills: To perform this job successfully, an individual should have knowledge of Word Processing software, Spreadsheet software and E-mail software Certificates and Licenses: None Supervisory Responsibilities: None Education/Experience: Minimum High school diploma or general education degree (GED). In addition, one to three months related experience and/or training preferred.