Denial Mgmt Technical Spec

About the Job

Location: NHRMC Business Center A

Department: Reimbursement

Full Time Equivalent: FTE: 1.000000

Work Type: 64 to 80 Hours Pay Period

Work Schedule: 8HR ROTATE - Rotating shifts

Exempt from Overtime: Exempt: No

What You'll Do

Summary:
The Denial Management Technical Specialist reports to the Director Revenue Recovery and is responsible for timely and accurate follow-up and appeal of denials/rejections received from third-party payers. The analyst will manage their assigned work to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered. In addition the analyst will assist Manager in identifying patterns, trends and root causes of denials for the purpose of preventing reoccurrence.

Responsibilities:
1. Responsible for denial work queues and reports in accordance with assignments from Manager. Maintains required levels of productivity while managing tasks in work queues to ensure timelines of follow-up and appeals.
2. Organizes denial/rejection related tasks to identify patterns and/or work most efficiently (e.g., by current procedural terminology, diagnosis, payer, denial reason code etc)

3. Identifies and monitors negative patterns in denials/rejections. Escalates accordingly to Manager to avoid negative impact on reimbursement, unsuccessful appeals, and/or increased write-offs. Work with Manager to compile examples of denials for use in addressing root causes with department(s) of origin. Use LEAN principles to assist departments with preventing denial reoccurrence.
4. Uses identified and known resources to accomplish follow-up on task. Identifies other means and resources to complete tasks, as applicable and appropriate.
5. As needed, participates in A/R clean-up projects or other projects identified by Manager.
6. Participates in departmental and team meetings involving discussion of A/R processes and trends.

Position Requirements

Credentials:

Education:
Essential:
* Associate Degree
Nonessential:
* High School Diploma

Other information:
1. Education: Associate degree or post HS required. In lieu of education, 4 years additional years of experience could be substituted, specifically in managing denials.
2. Licensure / Certifications: none
3. Experience: Minimum of 3 years in a hospital or physician billing office. Knowledge of medical terminology and billing/collection practices. Ability to read and interpret insurance explanation of benefits (EOBs). Knowledge of payer edits, rejections, rules and how to appropriately respond to each. Accuracy in identifying the cause of rejections/denials and selecting the most appropriate method for resolution. Demonstrated proficiency with timely and successful appeals to insurance companies. Ability to create professional correspondence to insurance companies and patients. Detail oriented and able to deliver neat and organized work. Self-motivation and ability to demonstrate initiative, excellent time management skills, and organization capabilities. Must be able to multi-task in a fast-paced environment and appropriately handle overlapping commitments and deadlines. Excellent analytical skills and creative problem-solving skills. Strong oral and written communications skills.
Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.
Performs other duties as assigned.
Individual will possess commensurate combination of education, experience and qualifications.