Denial Verification Specialist

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POST DATE 9/17/2016
END DATE 11/8/2016

Christus Health Houston, TX

Houston, TX
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
High School Diploma or GED



Responsible for the duties and services that are supportive to the Clinical Appeals Team. Clarifies and verifies details of government denials (Medicare and Medicaid) and Managed Care/Commercial denials. Tracks denial information, appeal due dates, and provides necessary details to The Clinical Appeals Nurses. Performs assigned duties such as contacting payers to verify an account has been denied, verify the reason for denial, obtain all pertinent information needed to submit an appeal, and follow up for decisions on all appealed accounts. Responsible for maintaining denial work queues. In doing so, ensures that all denials are referred to Appeals Nurses timely. Documents, forwards, resolves incoming mail and correspondence


- Contacts payers to determine reason for denials and obtain all pertinent information related to the denial

- Obtains necessary information needed to complete the appeal

- Follows up with payers on all appeal determinations

- Manages denial work queues and all denial referral sources

- Completes data entry in the Denial database for tracking, trends, and analysis

- Provides Clinical Appeals Nurses with details of the denial

- Contacts facilities for additional information when necessary

- Maintain contact with Patient Financial Services on issues related to claims and billing

- Assist in mailing out appeal letters and other office functions

- Any other duties as assigned by the Director


A. Education/Skills

- HS Diploma or equivalency required

- Post HS education preferred

- B. Experience

- Must have minimum of 2 years' experience with Medicare/Medicaid, Commercial/Managed Care insurance billing, collections, payment and reimbursement verification and/or refunds.

- General hospital A/R accounts knowledge is preferred

- College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.

- Experience with the Medicare/Medicaid, Commercial/Managed Care billing process

- Understanding of denial language

- Experience with Medicare Remote -- DDE

- Understanding of and exposure to Medicare Recovery Audit Contractor and Managed Care Audit process

C. Licenses, Registrations, or Certifications

None required