SERV Behavioral Health System, Inc.

Denial Specialist - Mercer County, NJ

US-NJ-Mercer County
3 weeks ago(11/27/2017 1:14 PM)
# of Openings
SERV Centers


Job Title:          Denial Specialist                                                                                                                                                                                                                                                          

Department:     Access to Care                                                


Reports to:       VP of Access and Continuum of Care


Job Summary:

The Denial Specialist is responsible for collecting payments for outstanding claims, researching denials, submitting appeals and ensuring payments are received and reconciled correctly; The Denial Specialist will work closely with the Billing Department and Programs to perform the necessary audits to evaluate the revenue cycle process and educate staff on issues impacting reimbursement; This position will execute the agency’s collections and patient accounts billing procedures.






  • Receives denial explanation of benefit from Billing department for denied services, and verifies denial reason for accuracy;
  • Communicates with payer to correct denial via phone, fax, email, resubmission of claim, appeal process or by means necessary per payer;
  • Runs aging reports for payers and assists with collection;
  • Monitors overpayments and processes for reimbursement;
  • Maintain knowledge of current government and carrier regulations relevant to industry;
  • Accurately and efficiently generate and format reports;
  • Communicates clearly and professionally, in both written and verbal manners with internal personnel, payers, providers, patients and other authorized representatives in regards to outstanding balances;
  • Identify and report trends in carrier payments and denials, which includes documentation of actions taken to resolve issues; Report findings to supervisor;
  • Review and take appropriate action against correspondence (including EOB’s, RA’s, denial letters) within a timely manner;
  • Responsible for all aspects of follow up and collections on accounts. This includes making outbound calls to payers and accessing payer websites;
  • Prepare paper claims (CMS-1500 and UB-04) and electronic claim submission to private insurances, Medicaid and Medicare for new and established patients, and COB’s for outpatient services;
  • Process billing calls and questions from patients and third party carriers;
  • Research, record findings, and communicate effectively with Supervisor to achieve optimum performance;
  • Process appeals; Submit with supportive medical documentation;
  • Ability to differentiate types of plans (PPO, HMO, MLTSS, MCO, Medicare etc.)
  • Ability to apply correct deductible, co-insurance, co-payment;
  • Ability to apply correct benefits for par, non-par providers, single case agreement;
  • Establish and maintain effective working relationships with patients, employees, and the public;
  • Participate in the Revenue Cycle Management Committee;
  • Cross-Train with ATC department team for referrals, authorizations, and eligibility;
  • Additional duties as assigned by VP of ATC;





Education & Experience: Certification in Medical Billing and Coding required; At least 3-5years of documented Medical billing/collection experience preferred; Behavioral health care billing/collection preferred; Knowledge of Medicare, Managed Care and Commercial insurance billing required; Associates degree preferred. Knowledge of CPT, HCPCS and ICD-10 coding, with ability to follow coding guidelines; Able to read and interpret EOB’s, Remittance Advice and identify denial codes; Able to understand and utilize Windows-based environment;


Special Skills: 

Excellent verbal and communication skills; Well organized, attention to detail, and ability to complete the job with minimal errors; Strong research and problem solving abilities; Exemplary customer service skills; Ability to prioritize and manage time effectively; Proficiency in Microsoft Office; Ability to identify trends in denials; Understanding of payer requirements for billing and appeals;



Required Knowledge, Skills and Abilities:


  1. Delegation - Assigns responsibilities and decision-making in a way that makes people responsible for results as well as determining appropriate means by which to achieve those results. Ensures that people are provided with sufficient resources to make decisions and take actions on their own. Appropriately outlines expectations and follows up accordingly.
  2. FLEXIBILITY/MANAGING STRESS – Demonstrates willingness and the ability to adjust to working with different types of people, stressful, or demanding situations, or adjusting one’s schedule in order to accommodate changes. Maintains a realistic interpretation of what constitutes a stressful situation. Functions effectively even when faced with stress and/or stressful situations. Effectively manages and controls stress-related responses in order to perform a job effectively and successfully.
  3. INITIATIVE - Is proactive rather than reactive both in thought and action. Identifies areas for improvement and takes necessary steps to implement those changes. Is a self-starter rather than waiting for direction from others.


  1. INTEGRITY - Acts in an honest and trustworthy manner based on personal responsibility and sound business ethics. Shows consistency among principles, values, and behaviors.


  1. LEADING OTHERS - Sets clear expectations for performance and responsibility and ensures that goals are met. Builds trust and respect among followers. Serves as a role model for appropriate attitudes and behaviors. Diagnoses the needs and capabilities of associates and takes actions to maximize each person’s development.


  1. MANAGING RESOURCES - Establishes goals, identifying a purpose, and setting clear objectives to guide actions for self or others. Organizes or adjusts information, people, and materials to meet established goals and priorities. Institutes effective methods for keeping track of the status of the subtasks and the overall timeline of a project and for ensuring that project goals are met in a timely manner.


  1. PROBLEM SOLVING - Is able to effectively resolve problems that involve people, things, and processes that require general logic and common sense. This may include gathering relevant information, considering alternatives, and drawing logical conclusions based on facts.


  1. Seeing the big picture - Is able to step back from detailed data analysis to understand how the analysis and/or implications of the analysis fit into a larger picture. Identifies and understands connections, interrelationships and cause-effect relationships among different pieces of data while not becoming too deeply mired in the details.


  1. TEAMWORK - Works effectively with others to accomplish goals. Effectively handles conflicts with other team members. Focuses first on the effectiveness and success of the team as a group. Is sensitive to the needs, strengths, weaknesses, and differences of individual players within the team.


  1. WORK ETHIC - Sets high standards for own work rather than solely following those that are expected. Successfully completes work with a careful attention to all aspects of the job. Assumes responsibility for a job well done. Is organized, neat, precise, hardworking, and dissatisfied with average performance.


SERV provides a positive and rewarding work environment in which people can help make a real difference in the lives of others. Our Core Values which include respect, embracing diversity & high standards of ethical conduct guide us in everything we do.



SERV is an Equal Opportunity Employer.



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