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Billing Denials Specialist

Weill Cornell Medical College

New York, NY
Weill Cornell Medical College
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Job Details

Position Summary

Under supervision, performs extensive follow\-up to investigate and resolve payment denials and trends

Job Responsibilities

+ Performs extensive follow\-up to investigate and resolve payment denial trends\.

+ May develop, maintain and/or disseminate departmental or functional specific policies and procedures\. May also be responsible for maintaining a departmental standard operating procedures \(SOP\) manual if available\.

+ Resolves outstanding accounts utilizing ancillary applications and websites as tools to retrieve medical documentation, claim status and billing guidelines to substantiate corrected claim submissions, written appeals, coding and medical necessity reviews\.

+ Attends workshops, seminars and/or conferences to keep abreast of standards and best practices within the field\. Disseminates information to colleagues and/or staff as appropriate\.

+ Researches and interprets payer contract terms and compiles necessary supporting documentation templates for appeals according to various payer claim guidelines\.

+ Reviews and reconciles accounts, financial transactions, documentation and/or financial reports\. Investigates and corrects discrepancies\. Escalates issues as needed\.

+ Ensures denial reviews are conducted in a timely manner and in accordance with Centers for Medicare and Medicaid Services and other third party payers, reimbursement and coding regulations including the institution's and departments compliance plans\.

+ Assists current and new employees in the use of systems/equipment and departmental policies and procedures\.

+ Participates in annual and on\-going mandatory compliance training\. Fulfills Continuing Education Units necessary to maintain certification status\.

+ Remains abreast of changes in policy by reviewing regular Medicare bulletins and other relevant resources\.

+ Develops standardized approaches for operational issues, reporting and quality analysis management\. Focus includes interface and system issues, invalid denial trends, payer specific carrier submission requirements and system optimizations\.

+ Utilizes Microsoft Excel and other reporting software to sort, filter, summarize and identify various account receivable trends\.


+ High School Diploma


Approximately 3\-5 years of physician billing experience, accounts receivable and collection experience

Knowledge, Skills and Abilities

+ Prior experience working with an eMR system\.

+ Demonstrated knowledge of medical terminology\.

+ Knowledge of third party reimbursement\.

Licenses and Certifications

Working Conditions/Physical Demands

Standard office work

Weill Cornell Medicine is a comprehensive academic medical center that's committed to excellence in patient care, scientific discovery, and the education of future physicians in New York City and around the world\. Our doctors and scientists\-faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and the Weill Cornell Physician Organization\-are engaged in world\-class clinical care and cutting\-edge research that connect patients to the latest treatment innovations and prevention strategies\. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where an international campus offers a U\.S\. medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey\. Our medical practices serve communities throughout New York City, and our faculty provide comprehensive care at NewYork\-Presbyterian Hospital/Weill Cornell Medical Center, NewYork\-Presbyterian/Lower Manhattan Hospital, and NewYork\-Presbyterian/Queens\. At Weill Cornell Medicine, we work together to treat each individual, not just their conditions or illnesses, as we strive to deliver the finest possible care for our patients \- the center of everything we do\. Weill Cornell Medicine is an Equal Employment Opportunity/Minorities/Females/Vet/Disabled employer\.
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