Physical Therapist Denials Management Specialist

Job Description

Are you a passionate and experienced Physical Therapist looking to expand your career into the realm of healthcare administration? Humana is seeking a dedicated and detail-oriented Denials Management Specialist with a background in Physical Therapy to join our dynamic team. In this role, you will utilize your clinical expertise to analyze and appeal denied claims, ensuring that our members receive the care they deserve. If you are a problem-solver with excellent communication and organizational skills, we invite you to apply for this unique opportunity to make a positive impact on our members' healthcare experiences.

Your Responsibilities

• Analyze and Appeal Denied Claims: Utilize clinical knowledge and expertise to review and analyze denied claims, identifying reasons for denial and formulating effective appeals to overturn denials.
• Ensure Quality Care for Members: Work diligently to ensure that Humana members receive the appropriate care they deserve by appealing denied claims and advocating for necessary treatments.
• Utilize Clinical Expertise: Utilize knowledge and experience as a Physical Therapist to accurately assess and review denied claims, ensuring that all appeals are supported by relevant clinical evidence.
• Communicate Effectively: Utilize excellent communication skills to effectively communicate with internal teams, insurance providers, and healthcare providers to gather necessary information and resolve issues related to denied claims.
• Maintain Organizational Standards: Maintain organization and attention to detail when reviewing and managing denied claims and appeals, ensuring accuracy and compliance with company policies and procedures.
• Collaborate with Team Members: Work collaboratively with other team members to share best practices and strategies for managing and appealing denied claims.
• Stay Informed: Stay up-to-date on changes in insurance policies and regulations related to claims denials and appeals, ensuring compliance and accuracy in all processes.
• Represent Humana: Serve as a representative of Humana when communicating with insurance providers and healthcare professionals, presenting a professional and knowledgeable image at all times.
• Make a Positive Impact: Take pride in making a positive impact on Humana members' healthcare experiences by successfully appealing denied claims and ensuring they receive the necessary care.
• Uphold Company Values: Uphold the values and mission of Humana in all actions and decisions, promoting a culture of quality care and ethical practices.

Equal Opportunity Employer

Humana is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.