PURPOSE OF THIS POSITION

The Denial Management Specialist is responsible for the timely review and accurate identification and follow-up of all initial denial notifications from Blanchard Valley Facility and Professional services as well as the appeal of denials/rejections from third-party payers. The specialist will manage their assigned work relating to all denials and ensure deadlines are met to achieve maximum reimbursement for services rendered. They will be required to work with multiple departments and communicate to the Denial Avoidance Specialist when identifying trends relating to denials. The specialist will also work with management to ensure compliancy within the department and to establish effective controls to adhere to applicable laws and regulations.

JOB DUTIES/RESPONSIBILITIES

• Monitors all aspects of denial work queues/tasks, and documents, tracks and communicates findings to Denial Avoidance Specialist and/or PFS educator to collaboratively resolve denials appropriately and timely.
• Identifies and monitors negative patterns in denials/rejections and monitors those denials effectively to maintain a required level of productivity to effectively reduce days in A/R.
• Develops and writes appeals for denials associated with the payment of claims within the department/division. Maintains appropriate timeliness of appeals for denials. Identifies other means and resources to complete tasks, as applicable and appropriate.
• Helps create and implement trend reporting to resolve issues and ensure compliance with third party negotiated rates and communicates inconsistency to the Denial Avoidance Team. Acts as a liaison to work with the Denial Avoidance and Education Team to resolve A/R and payer issues, avoid timely claim consideration/filing, failed appeals, and/or increased denials & write-offs.
• Participates in and helps coordinate meetings involving discussion of A/R processes, trends and denial resolutions to enhance billing functions and performance accuracy as needed.
• Responds to telephone traffic with patients, visitors and other hospital personnel in a courteous and timely manner. Relays accurate information promptly to the appropriate party for A/R reduction and patient satisfaction.
• Performs clerical functions such as data entry, typing and filing. Develops, interprets and utilizes computer reports as needed within all systems and data bases.
• Adheres to all HIPAA and BVHS security and privacy rules and regulations.

REQUIRED QUALIFICATIONS

• 2 years Patient Accounting/previous billing experience required
• High School graduate or GED equivalent
• Medical Terminology required
• ICD-9/ICD-10, HCPCS and CPT coding knowledge required
• An Advanced technical aptitude, proved PC literacy, proficient analytical skill in Microsoft suite of products required
• Effective communications both written and verbal. Ability to work with and communicate to a diverse work force in all levels of the organization
• Strong problem solving skills, ability to manage project tasks and timeliness. Possess analytical ability
• Positive service-oriented interpersonal and communication skills required
• Previous experience with denial management or the ability to interpret payer explanation of benefits required
• Knowledge of payer edits, rejections, rules, and how to appropriately respond to each
• Hospital or professional billing knowledge and an in depth understanding of denials and appeals required
• Ability to create professional correspondence to other healthcare professionals and patients and meet deadlines timely and accurately
• Strong Problem-solving skills and operation improvement orientation

PREFERRED QUALIFICATIONS

• College Degree or equivalent experience preferred
• Denial Management experience preferred

PHYSICAL DEMANDS

This position requires a full range of body motion with intermittent bending, squatting, kneeling, and twisting. The associate must be able to sit for 3 hours, walk for one hour and stand for two hours per day. The associate must be able to lift 20 pounds. The individual must have excellent eye/hand coordination to operate the machines. This position requires corrected vision and hearing in the normal range