::: {#description aria-label="Description"}::: {#jobDesc-row}Denial Specialist

　　GENERAL DESCRIPTION:

　　The Prior Authorization/Denial Specialist is expected to demonstrate an attitude of teamwork by creating a relationship with patient accounts, health information services, finance, clinical managers as well as administration.The position should maintain a constancy of purpose and continuous education of payer billing compliance and reimbursement regulations, especially for Indiana Medicaid, Clinic Option and Medicaid Rehabilitation Option.

　　DUTIES AND RESPONSIBILITIES:

　　Responsibilities include daily and/or weekly review of payer denials. This requires logging all denial reasons, patient name, account number, program, service activity code and clinician.In addition, a constant review of government and payer bulletins and memorandums that are specific to billing and coding changes specific to behavioral health and addictions is required.

　　DIRECT DUTIES:

　　Constant review of all remittance advice and explanation of benefits for zero pays and denials.

　　Log all denials by reason code.

　　Address denial issues with management.

　　Monitor billing and medical policy notices from all payers.

　　Solicit assistance from clinical, health information and/or quality personnel to resolve denial issues.

　　Process and submit appeals when appropriate to all payers.

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