Denial Management Specialist in Louisville, KY at ResCare

Date Posted: 7/5/2018

Job Snapshot

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Job Description


Title: Denial Management Specialist

Job Category: Direct Care/Operations

Line of Business: Resource Center Services

About ResCare

Join us in transforming peoples' lives and their communities! ResCare is a one-of-a-kind human services company offering services for people with intellectual and developmental disabilities, home care for seniors, as well as education, vocational training, and job placement for people of all ages and skill levels. Right now, we have an exciting opportunity for you to join our team as a Denial Management Specialist.

About this Line of Business

Since 1974, ResCare, Inc., has been dedicated to impacting communities for the better with a mission to help people live their best life. As the largest diversified health and human services provider in the U.S., ResCare makes a difference in people's lives and communities by providing home and community-based health services to complex populations.

With more than 45,000 dedicated employees serving over 60,000 people daily across the country, ResCare offers daily living, behavioral health and other health-related support services, pharmacy, remote monitoring solutions, neurorehab therapy, along with vocational training and job placement for people of all ages and skill level.

ResCare is changing the industry through our commitment to continuous quality and safety improvements, and we're investing in technology to connect homes and people. We're also working with federal and state government agencies to educate and advocate for the use of those needed care solutions to improve quality outcomes and reduce costs.

As a(n) Denial Management Specialist you will: 

Denial management specialist is responsible for reviewing and researching all billing denials that have been received from the payor. This would include identifying the root cause of the denial and providing denial resolution in a timely manner. 

Essential Job Responsibilities:

  • Reviews and researches claims in which a denial payment has been received from the payer in a timely manner.
  • Manages and Develops necessary department and executive level reporting
  • Identifies the root cause of the denial and addresses the denial issue with the appropriate department (i.e. Billing, CDM, Clinical Documentation, Coding, etc.)
  • Utilizes all appreciate systems to effectively research claims and complete steps to submit information necessary to process or appeal claims
  • Investigates and ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims
  • Completes and requests adjustments to a claim, as appropriate, based on the dollar threshold of the adjustment
  • Reviews, works and reports all claims that have aged more than the specified grace period stipulated in policies and / or contacts
  • Organizes work/ resources to accomplish objectives and meet deadlines
  • Demonstrates problem- solving skills related to denial analysis
  • Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively to obtain necessary information to address denial management issues
  • Meets productivity requirements to ensure excellent service is provided to customers
  • Maintains compliance with established corporate and departmental policies and procedures
  • Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, customers and co-workers
  • Identify all denial trends and provide education of steps to prevent future avoidable denials.
  • Initiate/Manage all appeals in a timely manner.
  • Organize the work flow to ensure that denials are worked according to timely filing deadlines and conditions of payment.
  • Communicate all denial trends and denial increases to direct supervisor in order to positively affect the volume of denials.
  • Building relationships with payors.
  • Complete special projects as assigned by Supervisor/Manager.

Position Requirements

  • High School Diploma required;  Bachelor’s Degree preferred
  • At least 3-5 years of experience in revenue cycle and/or billing experience 
  • Denial Management and/or electronic billing experience are preferred
  • Highly motivated individual with attention to detail in fast paced environment
  • Good internal/external customer communication skills required
  • Able to work independently and collaboratively as a team player
  • Systems include Excel, Power Point, Zirmed billing system

Additional Information


ResCare offers a comprehensive benefits package to full-time employees including medical, dental, vision, paid time off, disability, life, and tuition reimbursement. All employees age 21 and older are eligible to participate in the 401(k) retirement savings plan.

ResCare is an Equal Opportunity Employer. ResCare does not discriminate against any person on the basis of gender, race, color, national origin, religion, disability, age, veteran status, gender identity or sexual orientation in admission, treatment, or participation in its programs, services and activities, or in employment, or on the basis of gender in its health programs and activities.

9901 Linn Station Rd FL 6 - 11 , Louisville, KY 40223-3824 USA