
RCM Healthcare Claims Denials Specialist
Are you a detail-oriented and analytical individual looking for a challenging and rewarding career in the healthcare industry? Humana is seeking a talented RCM Healthcare Claims Denials Specialist to join our team and assist with managing and resolving claim denials. In this role, you will play a crucial part in ensuring accurate and timely reimbursement for medical services provided to our members. As a Denials Specialist, you will have the opportunity to utilize your expertise and problem-solving skills to make a positive impact on our organization and the lives of our members. Join us and be a part of a team dedicated to improving the health and well-being of our communities.
- Review and analyze all denied healthcare claims to determine root causes and identify patterns or trends.
- Collaborate with internal teams, including revenue cycle management and provider relations, to address and resolve claim denials.
- Communicate with healthcare providers to obtain necessary information and documentation for claim appeal submissions.
- Utilize industry knowledge and best practices to develop effective strategies for reducing claim denials.
- Conduct thorough research and investigations to determine the appropriate course of action for each individual denied claim.
- Maintain accurate and detailed records of all denied claims, including reason for denial and actions taken to resolve.
- Keep up-to-date with changes in healthcare regulations and payer policies to ensure compliance in all claim denial processes.
- Provide timely and efficient responses to any inquiries or escalations related to claim denials.
- Work closely with team members to identify process improvement opportunities and implement solutions to enhance the overall efficiency and effectiveness of the denial management process.
- Collaborate with cross-functional teams to develop and maintain training materials and resources to ensure consistent understanding and application of denial management processes.
- Participate in meetings and presentations to share insights and recommendations for improving claim denial rates.
- Maintain a high level of confidentiality and professionalism in handling sensitive information related to member and provider data.
- Uphold Humana's values and commitment to providing quality healthcare services to our members.
- Continuously assess and improve personal knowledge and skills in the healthcare industry to stay current with industry trends and best practices.
Knowledge Of Healthcare Claims Processing: A Rcm Healthcare Claims Denials Specialist At Humana Should Have A Thorough Understanding Of The Healthcare Claims Process, Including Coding, Billing, And Reimbursement Procedures.
Understanding Of Insurance Regulations: Familiarity With Federal And State Regulations Related To Healthcare Claims, Including Medicare And Medicaid Guidelines, Is Essential For This Role.
Experience With Claims Denials Management: Applicants Should Have Hands-On Experience In Managing Claims Denials, Including Identifying Root Causes, Developing Strategies For Resolution, And Effectively Communicating With Internal And External Stakeholders.
Proficiency In Medical Coding: A Strong Understanding Of Medical Coding Systems, Such As Cpt, Hcpcs, And Icd-10, Is Vital For Accurately Reviewing And Analyzing Claims Data.
Communication And Problem-Solving Skills: The Ability To Effectively Communicate And Collaborate With Team Members, Healthcare Providers, And Insurance Companies Is Crucial For Resolving Claims Denials. Candidates Should Also Possess Strong Problem-Solving Skills To Identify And Implement Solutions To Complex Claims Issues.
Communication Skills
Attention to detail
Analytical Thinking
Claims Processing
Medical Terminology
Teamwork
Problem-Solving
Medical coding
Insurance Knowledge
Billing Procedures
Denials Management
Communication
Conflict Resolution
Leadership
Time management
Organization
Critical thinking
Attention to detail
Teamwork
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a RCM Healthcare Claims Denials Specialist in Atlanta, GA, USA is $55,000 to $76,000 per year. This can vary depending on the specific company, years of experience, and other factors.
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Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.

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