Under general direction of the Director, Revenue Cycle and guidance from the Denials Management Senior Analyst, the Denials Patient Account Rep is responsible for reviewing denied claims and carrying out the appeals process. Works to maintain third-party relationships, including responding to inquiries, complaints, and other correspondence. Knowledgeable of state/federal laws that relate to contracts and to the appeals process. Assists the Denials Management Senior Analyst with reports and provides ongoing support and maintenance to the Revenue Cycle process to maximize case flow and reduce denied claims.
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Core Competencies | |
- Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner.
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- Tracks the status and progress of denials and appeals.
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- Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms.
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- Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues.
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- Utilizes the Hospital's contract management system to identify accounts paid less than the expected reimbursement.
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- Prepares, maintains, assists with, and submits reports, as required.
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- Works with internal departments and external organizations to resolve appeals.
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- Prioritizes workload requests to meet agreed upon deadlines.
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- Collaborates with team members to continually improve services and engages in process and quality improvement initiatives.
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- Identifies improvement opportunities and contributes to the testing of system modifications; works with IT staff and department managers to ensure proper implementation.
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- Identifies and resolves problem issues independently.
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- Elevates issues as appropriate to Supervisor.
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- Promotes positive customer relations.
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Department Specific Competencies | |
- Answers the telephone courteously within three rings, identifying self and department, routes calls, ascertains needs and takes accurate messages as appropriate.
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- Interprets patient insurance benefit information and explains the amount allowed and paid by the customers insurance plan and how the amount owed by the patient was determined.
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- Maintains advanced knowledge of payer-specific billing, claims processing requirements, payer regulations and payer best practices.
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Education |
| Degree | Program |
| Additional Information |
| Bachelor's degree in business, healthcare, or related field or Associate's degree with 3 years of patient financial services. |
Experience |
| Number of Years Experience | Type of Experience |
| 2 | Healthcare billing, collections, payment processing or denials management |
Compensation Range $25.64 - $38.82 / Hour |
