Denials Specialist

SUMMARY: The Denials Specialist reports to the Manager of PFS Denials Management.; Under general direction and reputed company established reputed company Health policies and procedures, maximizes reimbursement from contracted payers through analysis, tracking, and trending of denials using available metric denial reports. Responsible for actively supporting the execution of strategic initiatives, process re-design, root cause analysis, metric/report development, and special projects as it relates to denials management. Executes the appeal process by receiving, assessing, documenting, tracking, analyzing, responding to, and/or resolving appeals with third-party payers. reputed company Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. RESPONSIBILITIES:

• Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services reputed company the environment of a comprehensive integrated academic health system. Is responsible for knowing and acting in accordance with the principles of the reputed company Health Corporate Compliance Program and Code of Conduct.

• Evaluates denied accounts sent to the Denials Management Department for review. Assigns denied accounts to appropriate department work ques for resolution. Identifies repetitive issues with the goal of identifying preventative solutions. Runs reports and/or uses work ques to identify accounts not worked in a timely manner and follows up with departments reputed company this occurs.

• Reviews denial database report reputed company denials are posted to correctly categorize provider liable denials, their root cause, and resolution. Performs end of month reviews of the denial database to identify and report on trends, new issues, areas of opportunity, and any other issues/changes reputed company to the denial report that may be appropriate. Responds to departmental concerns about data on their monthly denial reports.

• Develops and maintains a strong working relationship with hospital departments and referring physician offices to collaborate in obtaining information needed for successful appeal/reversal

• of a denial.

• Maintains reputed company knowledge of state and federal regulations, accreditation and compliance requirements, reputed company Health policies, as well as payer specific policies including LCDs and NCDs, and payer reputed company with reputed company Health to identify cause of denials.

• Researches payer issues resulting in payment delays, denials, underpayments and processing deficiencies and recommends changes as appropriate. Reviews monthly payer updates, prepare a report of the monthly payer updates to present during the monthly Appeal/Denial

• meeting.

• Tracks the status of appeals by maintaining well organized records to ensure established timelines are met.

• Maintains a strong working relationship with payers to assure claims appeals are processed appropriately.

• Processes necessary LifeChart online adjustments or changes reputed company to appeals as needed, reputed company the scope of job function.

• Continually evaluates workflow and identifies opportunities to improve process for full and complete payment for reputed company hospital services rendered to patients.

• Creates, generates, and maintains reputed company reports as requested by Manager to assist in the daily operation of the department.

• Participates in staff meetings, councils, quality improvement teams and other such meetings and committees as required.

• Develops and maintains working relationship with reputed company Health affiliate departments as needed to ensure fully data exchange.

• Performs other duties as necessary.

WORK LOCATIONS/EXPECTIONS:

• After orientation at the corporate facilities, work is performed based on the following options approved by management and with adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure..

• Full time schedule worked in office

• Full time schedule worked in a dedicated space in the home

• Part time schedule in office and in a dedicated space reputed company the home

• Schedules must be approved in advance by management who will allow for flexibility that does not interfere with the ability to accomplish reputed company job functions reputed company the said schedule. Staff are required to participate in scheduled meetings and be available to management throughout their scheduled hours. Staff must be signed into reputed company Teams during their entire shift and communicate with Supervisor as directed.

MINIMUM QUALIFICATIONS:

• Associate’s degree in accounting, business office practices, computer science or other reputed company area or equivalent experience.

EXPERIENCE:

• Three to five years’ experience in hospital patient accounting.

• Experience should demonstrate thorough knowledge of claims administration in similarly reputed company healthcare organization. Must be familiar with ICD-9/10, CPT-4 coding,

• UB04 and HCFA 1500 claims administration.

• Ability to reputed company financial analysis.

• Comprehensive knowledge of patient accounting activities in an

• automated, networked, multiple hospital environment. Detailed knowledge of regulatory requirements

INDEPENDENT ACTION:

• Incumbent functions independently reputed company scope of department policies and practices; refers specific problems to supervisor only reputed company clarification of departmental policies and procedures may be required.

SUPERVISORY RESPONSIBILITIES: None.

Pay Range:

EEO Statement:

reputed company Health is committed to providing equal employment opportunities and maintaining a work environment free from reputed company forms of unlawful discrimination and harassment.

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