Denial Management Lead supports leadership in monitoring tasks related to insurance follow-up and denial management functions. This position requires quick responses to patterns/trends seen in claims processing and the ability to provide
quick resolutions and/or bring attention to the direct supervisor. The Lead will help ensure denied claims are worked timely to ensure payment, and help education staff, providers and others on denial reasons to ensure denials are kept to a
Tracks the status of all denied claims and unpaid claims from commercial and Medicaid payers.
Helps ensure timely and complete follow up on unpaid or denied claims.
Provides daily/weekly updates to Supervisor regarding assigned tasks.
Helps ensure complete and accurate posting of all payer payments.
Timely submits issues that caused unpaid claims to the attention of the Supervisor so so they are addressed and
claims are resubmitted in timely fashion.
Complete complex tasks relating to insurance verification, resolution of aging accounts, resolution of patient
complaints, and client customer service.
Review complex denials and refund requests, dispute or appeal as necessary.
Contact vendors regarding denials or benefit coverage.
Maintain, track and reports grant payment and denials.
Research, identify and facilitate resolution to complex problems with overdue or unpaid accounts.
Ensure all actions, job performance, personal conduct and communications represent CommUnityCare in a highly
professional manner at all times.
Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission
and values of the organization.
Answer and resolve telephone inquiries from internal and external sources.
Perform other duties as assigned.
High level of skill at building relationships and providing excellent customer service.
Ability to utilize computers for data entry, research and information retrieval.
Strong attention to detail and accuracy.
Ability to multitask.
Excellent verbal and written communication skills.
Ability to understand complex insurance issues, including assigning correct payer, adjustments and refunds to
Must be able to effectively monitor steps in claims processing operations.
Must have excellent computer, time management, organizational, data processing, and analytical skills with
proficiency in Excel and Microsoft Office Suite as well as A/R systems and associated applications required
Must have highly developed problem-solving skills.
People Management/Department Management/Business Unit Management:
Executes excellent customer service and professionalism when interacting with staff, payers, patients, and
families to ensure all are treated with kindness and respect
Through leadership and by example, ensures that services are provided in accordance with state and federal
regulations, organizational policy, and accreditation/compliance requirements
Acts in accordance with CUC’s mission and values, while serving as a role model for ethical behavior
Promptly identify issues and reports them to direct Supervisor
Maintain regular and predictable attendance
Assist staff with their work que(s) and resolving issues.
High School Diploma
2‐3 years equivalent experience
Advanced knowledge of medical terminology, ICD‐10, CPT, HCPCS coding and HIPAA
Extensive knowledge of billing and collection processes and procedures
Extensive knowledge and experience with third party government billing and reimbursement
Demonstrated proficiency in the use of computer and commonly used software
Experience working with FQHC billing and revenue cycle activities
1‐2 years’ experience in a leadership role
Certified Professional Coder (CPC) or Certified Professional Biller (CPB)