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3.3 | Cambridge, MA | Hospital & Health Care | 10000+ Employees
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Posted a month ago on Sept. 22, 2020

Denial Specialist

Full-time in Plymouth, MN
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Paid Time Off
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Ability to Telecommute
Wellness Initiatives
Philips is a hospital & health care company headquartered in the Cambridge, MA area with 10000+ employees. Philips has a 3.3-star InHerSight Score, based on 1,197 ratings from 83 employees. Employees have left 23 comments about their experiences working for the company on InHerSight.

Job Title

Denial Specialist

Job Description

We welcome you to join Philips Sleep and Respiratory Care (SRC) business as a Denial Specialist in our Plymouth, MN location.

As the Denial Specialist, you will be responsible for validating denial reasons following the Explanation of Benefits (EOB)/Remittance Advice review, escalating payment variance trends and/or issues to management and make corrections for denied or underpaid claims.

You are responsible for

  • Validate denial reasons, ensure coding on claims are accurate and reflect the true denial reasons.
  • Coordinate with Billing, Reimbursement and Cash Application when necessary to resolve discrepancies.
  • Contacts payers telephonically or through written correspondence to provide or seek information to resolve claim denials.
  • Generate initial appeal based on the dispute reason and contract terms to the payer.  This includes online provider disputes and reconsiderations.
  • Update claims corrections within established turnaround times to ensure prompt and accurate payment of claims.
  • Perform research and make determination of corrective actions on claims and takes appropriate steps and route claim appropriately.
  • Escalate denial or payment variance trends to management team for payer escalation.
  • Work payer projects related to denials.
  • Updates claims related to change of insurance.
  • Understand business implications of decisions.  
  • Maintain strict confidentiality of patient personal information.
  • Maintain HIPPA compliance.
  • Perform other duties as assigned.

Processes, Procedures and Systems (10%)

  • Review, understand and follows department policies, Standard Operating Procedures and job aides.
  • Notify management of any defects or enhancement opportunities for SOP’s and job aides.
  • Assist with annual review of SOP’s and job aides.

Mentoring and Special Projects (10%)

  • Assist peers in answering processing questions and assists in training new hires.
  • Notify Supervisor and Manager of any defects or enhancement opportunities for SOP’s and job aides.
  • Serves as subject matter expert in the absence of the supervisor.
  • Collaborates with external and internal team members and customers to create a positive experience for customers and minimizes days sales outstanding (DSO) and denials and maximizes cash collections.

To succeed in this role, you should have the following skills and experience

  • Bachelor’s degree or equivalent work experience or combination of secondary education
  • Work experience in a healthcare related setting
  • 4+ years of direct work experience related to medical claims billing/collections, insurance, appeals, and/or authorizations.
  • Proven excellent verbal and written communication skills
  • Strong computer skills, including word processing and spreadsheet software

Physical Requirements: Candidate must be able to sit at a desk in front of a personal computer (PC) monitor for long periods. Position requires incumbent to use a PC, telephone, and basic office equipment. This position requires the candidate have the ability to conduct telephone conversations, read medical and insurance information and communicate clearly with all internal and external customers

You are part of

A company comprised of the best and brightest people working to improve the lives of 3 billion people a year by 2030.  A culture of diverse people and ideas who believe there’s always a way to make life better. A greater purpose that means we come to work thinking about what we can to do to help prevent, diagnose and treat life’s most threatening diseases, solve the most challenging issues facing health systems, and find new ways to bring access to care to those who need it most.

In return, we offer you

We offer you the opportunity to grow within the organization and Philips – develop strong partnerships across Procurement, Head of Manufacturing, Q&R, Business Unit’s, and Group Functions on various projects and initiatives to drive our products to our customers and be a part of saving people’s lives every day.

Why should you join Philips?

Working at Philips is more than a job. It’s a calling to create a healthier society through meaningful work, focused on improving 3 billion lives a year by delivering innovative solutions across the health continuum. Our people experience a variety of unexpected moments when their lives and careers come together in meaningful ways. Learn more by watching this video

Find out more info about Philips at

It is the policy of Philips to provide equal employment and advancement opportunities to all colleagues and applicants for employment without regard to race, color, ethnicity, religion, gender, pregnancy/childbirth, age, national origin, sexual orientation, gender identity or expression, disability or perceived disability, genetic information, citizenship, veteran or military status or a person’s relationship or association with a protected veteran, including spouses and other family members, marital or domestic partner status, or any other category protected by federal, state and/or local laws.

As an equal opportunity employer, Philips is committed to a diverse workforce. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veterans' Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants that require accommodation in the job application process may contact 888-367-7223, option 5, for assistance.

Equal Employment and Opportunity Employer/Disabled/Veteran



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