Denial Management Specialist in Louisville, KY at ResCare

Date Posted: 2/27/2018

Job Snapshot

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Job Description


Title: Denial Management Specialist

Job Category: Finance & Accounting

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.

Are you passionate about helping others? Don’t miss this opportunity to find career success and fulfillment while you help people reach their highest level of independence! Apply today! ResCare. Where Care Meets Career.

Denial Management Specialist Responsibilities

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 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.

Specific 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


In addition to meeting your passion for making a difference in people's lives and career advancement, opportunities you may also be offered:

  • Competitive pay based on experience
  • Medical, Dental, Vision Benefits
  • Suite of voluntary insurance options
  • 401(k)
  • Paid Time Off
  • Holidays
  • Performance incentives
  • Company Discount Purchasing Program
    • Cell phone Service
    • Ford and Chrysler Automobiles
    • Furniture
    • Appliances
    • Staples discounts
  • Employee Assistance Program
  • Legal Assistance Program
  • Tuition Reimbursement

Don't miss this opportunity to find career success and fulfillment while you assist people to reach their highest level of independence. 

ResCare does not discriminate against any person on the basis of gender, race, color, national origin, religion, disability, age, veteran status, 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 Road , Louisville, KY 40223-3808 USA