Pay Range:

$18.18-$32.73 Hourly

Wage offered depends on job-related experience, knowledge, and skills.

Job Title: Medicare Denials Follow-up Specialist

Department:Patient Financial Services

Reports to:Director of Patient Financial Services

Classification:Hourly

Position Overview:

We are seeking a detail-oriented and experienced Medicare Denials Follow-Up Specialist to join our team. The ideal candidate will possess a strong understanding of Medicare regulations and guidelines, with specific expertise in handling denials and appeals.

Required Education, Licensure, Certifications, & Experience:

High school diploma or equivalent.
6 years of experience in Medicare claims processing and denials management.
3 years of EPIC experience required
Recent experience working with EPIC EMR system.
Familiarity with Waystar or similar revenue cycle management software for claims processing and denials management.

Preferred Education, Certifications, & Experience:

Bachelor’s degree.
CPC, CRCR, or CPMA certifications.

Essential Functions:

Analyze Medicare denials and determine the appropriate course of action for appeal or resubmission.
Prepare and submit appeals for denied Medicare claims, ensuring accuracy and compliance with regulatory requirements.
Collaborate with internal teams, including billing, coding, and clinical staff, to gather necessary information for appeals and resolve denial issues efficiently.
Maintain detailed records of denial cases, including appeals filed, communications with Medicare representatives, and any additional documentation required.
Monitor the status of appealed claims and follow up with Medicare representatives as needed to expedite resolution.
Provide education and training to staff on Medicare regulations, denials management best practices, and documentation requirements to minimize future denials.
Generate and analyze reports on Medicare denials trends, identify root causes, and make recommendations for process improvements.

Non-Essential Functions:

Any other duties as needed to drive towards the vision, fulfil the mission, and abide by the values of the organization.

Required Skills:

Ability to analyze denial reasons, identify trends, and develop strategies for minimizing denials.
Excellent written and verbal communication skills, with the ability to effectively communicate with internal staff and Medicare representatives.
Strong attention to detail and accuracy in documentation and appeals submissions.
Ability to collaborate effectively with multidisciplinary teams to achieve common goals.
Demonstrated proficiency in using the Direct Data Entry (DDE) system for Medicare claims processing and appeals.
Thorough understanding of Medicare billing regulations, coverage guidelines, and appeals process.

Physical Requirements:

Sitting: 90%. Standing/Walking: 10%
Occasional lifting/carrying of supplies and paper weighing up to 40 pounds.
Occasional pushing/pulling to move supplies and equipment.
Occasional climbing of stairs to reach other levels of the building.
Occasionalstooping/kneeling/bending/crouching to file in low cabinets, purge old bills and to print forms.
Occasionalreaching/handling/fingering to complete paperwork, use computers, file, and answer telephones.
Frequenttalking/hearing/seeing to interact with staff and customers to complete assigned tasks.

Environmental Conditions:

Location: Inside.
Occasional exposure to noise from printers, telephones and fax machines.
Minimal risk of injury due to proximity of moving parts on computer printer, typewriter, and copier.
Minimal exposure to fumes and caustic materials from copy machine toner and cleaning supplies.
Minimal exposure to biohazardous materials.

Travel Requirements:

If not in the Palouse area, will need to travel to Pullman for New Employee Orientation week

We believe Pullman Regional Hospital is extraordinary.

We are an independent, patient and employee-focused, award-winning organization with a unique, collaborative and inclusive culture.

On a daily basis, our 600+ employees serve patients and communities through Pullman Regional Hospital, the Foundation, and our growing network of clinics. We are one of the largest employers in Pullman, WA, and a community leader in healthcare activities. Together, we continue to raise the bar of expectation for quality healthcare and the patient experience. In this way, the extraordinary for all others becomes the expected at Pullman Regional.

Our greatest asset is our people. That’s why we hire passionate people who are aligned with our mission to nurture and facilitate a healthier quality of life for our region.

If you have a passion for health and healing, enjoy helping people, and want to work for an organization that values a growth mindset, we can’t wait to meet you!

Pullman Regional Hospital remote jobs

Coding Manager (Remote Option Available)

Patient Account Representative ll (Epic experience required; remote option)

Medicare Denials Follow Up Specialist (EPIC experience required) remote option