Demo

Denials Appeal Rep TC

Hasbro Children's
Providence, RI Part Time
POSTED ON 1/24/2025
AVAILABLE BEFORE 2/21/2025
Summary

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">The Denial Appeal Representative

reports to the Patient Financial Services Technical Appeals Supervisor. Under general direction and within

established Brown University Health policies and procedures performs all

administrative/clerical support duties needed to maximize reimbursement from

contracted payers. Executes the appeal

process by receiving assessing documenting tracking analyzing responding

to and and/or resolving appeals with third-party payers. Uses available metric

denial reports to analyze track and trend denials using available metric

denial reports. Processes a thorough understanding of all aspects of claim

related errors and the ability to adjust or changes related to denials as

needed within the scope of job function.

Responsibilities

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">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 within the environment of a comprehensive integrated academic health

system. Is responsible for knowing and

acting in accordance with the principles of the Brown University Health Corporate Compliance

Program and Code of Conduct.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Provides administrative/clerical

support to the denials appeals process which includes receiving assessing

documenting tracking responding to and /or resolving denials with third

party payers in a timely fashion.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Ability to process and organize a

large volume of record requests document scanning telephone calls electronic

record documentation requirements.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Evaluates denied accounts sent to

the Denials Management Department for review. Assigns denied accounts to

appropriate department work queues for resolution. Identifies repetitive issues

with the goal of identifying preventative solutions. Uses reports and work

queues to identify accounts not worked in a timely manner and follows up with

clinical and financial departments when this occurs.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Tracks the status and progress of

appealed activity and payer appeal responses using work queues and

well-organized records to assure established timelines are met.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1"> Researches payer issues resulting in payment

delays denials underpayments and processing deficiencies and recommends

changes as appropriate. Review monthly payer updates that will be reported

during the monthly Appeal/Denial meeting.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Maintain a strong collegial

working relationship with payers to assure claims/appeals are processed

appropriately.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Processes necessary Lifechart

online adjustments or changes related to appeals as needed within the scope of

job function.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Continually evaluates work flow

and identifies opportunities to improve process for full and complete payment

for all hospital services rendered to patients to include the need for system

updates after careful analysis.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Creates generates and maintains

ad hoc reports as requested by Manager to assist in the daily operation of the

department.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Participates in staff meetings

councils quality improvement teams and other such meetings and committees as

required.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Develops and maintains working

relationship with Brown University Health affiliate departments as needed to ensure full data

exchange.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Performs other duties as

necessary.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">WORK LOCATIONS/EXPECTIONS:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">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..

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">� Full

time schedule worked in office

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">� Full

time schedule worked in a dedicated space in the home

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">� Part

time schedule in office and in a dedicated space within the home

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Schedules must be approved in

advance by management who will allow for flexibility that does not interfere

with the ability to accomplish all job functions within 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

Microsoft Teams during their entire shift and communicate with Supervisor as

directed.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

Other Information

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">BASIC KNOWLEDGE:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">High School Graduate or

equivalent. Experience and knowledge in hospital patient accounting or

denials/appeals in similarly complex healthcare organization. Must be familiar with ICD-9/10 CPT-4 coding

UB04 and HCFA 1500 claims administration. Demonstration of highly developed

organizational ability communication skills and problem-solving skills.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">EXPERIENCE:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Three to five years� experience

and knowledge in hospital patient accounting or denials/appeals in similarly

complex healthcare organization. Must be

familiar with ICD-9/10 CPT-4 coding and Microsoft Office tools UB04 and HCFA

1500 claims administration. Ability to

perform financial analysis.

Comprehensive knowledge of patient accounting activities in an

automated networked multiple hospital environment. Detailed knowledge of regulatory requirements

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">INDEPENDENT ACTION:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">Incumbent functions independently

within scope of department policies and practices; refers specific problems to

supervisor only when clarification of departmental policies and procedures may

be required.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">SUPERVISORY RESPONSIBILITIES:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:

minor-latin;color:black;mso-themecolor:text1">None.

Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location: Brown University Health Corporate Services USA:RI:Providence

Work Type: Part Time

Shift: Shift 1

Union: Non-Union

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