Customer Service and Denial Specialist

Overview We are seeking a skilled and dedicated Customer Service and Denial Specialist to join our healthcare team. Iowa Radiology is a patient-centered practice that promotes a more compassionate approach to medicine. We provide our employees the ability to bring their authentic selves to work every day, providing compassionate care for our patients in a collaborative, supportive work environment.

Location: This is primarily a remote position Schedule: Monday - Friday, normal business hours Status: Full-time, 40 hours per week We want YOU to join the Iowa Rad family!

We truly care about our employees, their health and well-being, and their career goals and aspirations. The ideal candidate will play a crucial role in helping us continue to be the premier provider of radiologic services in Iowa by providing high-quality imaging services, ensuring patient safety, and delivering accurate diagnostic information.

Competitive Benefits Package including but not limited to:

• Health, Dental, and Vision Insurance
• Life Insurance
• Short-term and Long-term Disability Insurance
• Paid Time Off and Paid Holidays
• 401k Retirement Plan
• Referral Program

Responsibilities: Denial Specialist (approx. 40%) Work from the Denial Tickler in Imagine (or claims assigned by the Team Lead or Billing Manager), review denied claims and decide on the action needed for resolution. Determine whether:

• The denial is justified. Document the finding and either change the balance to patient responsibility or refer the claim to the Team Lead or Billing Manager for adjustment/write-off approval.
• An appeal is needed. If so, prepare and submit the appeal.
• An inquiry to the carrier is needed to gather further information (via email, web-based inquiry, or phone call).
• Corrections are needed (insurance policy IDs, prior authorization information, etc.). Make corrections and refile the claim or submit a corrected claim. Work with coding staff when the denial is coding-related, or if any coding (CPT/ICD-10/modifier) changes are needed these must be completed, approved by a certified coder.
• Additional information is needed from the ordering provider’s office, such as insurance information, medical necessity documentation, records, or orders.

In addition:

• Understand the levels of appeal and the process for each insurance carrier.
• Track timely filing and appeal deadlines and prioritize work accordingly.
• Track and communicate carrier-specific requirements and denial trends to Billing and Coding managers.
• Apply knowledge of billing and claims processing to patient accounts.

Follow-Up (approx. 25%)

• Investigate outstanding claims from the outstanding tickler queue in the billing system. Use insurance carrier websites and phone contact to determine claim status and take appropriate action to resolve issues preventing processing.
• Provide credit balance information to the refund department when necessary.
• Provide payment posters with documentation to post insurance responses when appropriate.

Customer Support (approx. 20%)

• Assist patients with account inquiries received through inbound telephone calls, written correspondence, emails, and voicemails.
• Process credit card payments through the merchant processing system in accordance with PCI requirements.
• Provide price quotes and billing expectations for upcoming appointments, including good faith estimates for self-pay or uninsured patients where applicable.
• Work with patients to set up reasonable payment plans and help them execute payment methods to ensure timely payments.
• Work with clinic staff to answer billing and balance inquiries in the patient-facing clinics.

EDI and Administrative (approx. 15%)

• Review electronic claim rejections from payers, research the rejection message, make necessary changes, and rebill the services.
• Review pre-eligibility checks, verify that suggested charges are appropriate, and make necessary changes.
• Review return mail from patients and insurance companies; research and take necessary action based on protocols.
• Review, document, distribute, resolve, and scan miscellaneous correspondence from incoming mail or fax.
• Review health insurance claim forms (CMS-1500/UB-04) and attached information for accuracy.
• Scan and index documentation into the document management system.

General Responsibilities

• Work with clinic staff answering billing and balance inq…