Denial Management Specialist

Overview

Under general supervision, this position is responsible for the receipt, investigation and creation of the data record for medical necessity audits and denials. Reviews referrals for appropriateness and gathers information necessary for assigning appeal to appropriate clinical team.  Contacts vendors, insurance companies, and other departments regarding appeal status and utilization review activity.  Coordinates the preparation and posting of appeal packets.  

Key Responsibilities

• Create and update denial tracking records consistently and thoroughly throughout the appeals process. 
• Research denials to obtain a complete and accurate picture of the payer’s evaluation and what led to a denial.
• Proactively seek out denial correspondence that originates from various sources both internal and external to the Central Business Office (CBO).
• Appropriately assigns denials to clinical team.
• Prints medical record, scans correspondence and prepares appeal packet.
• Establishes and maintains communication with immediate team, CBO team, affiliate hospital’s UR department, vendors and payers to assist in resolving issues impacting appeals and recovery of denied revenue. 
• Shares information with the team and leadership to ensure the integrity of the denial information, identify performance improvement opportunities and supports the clinical teams’ ability to prioritize, triage and overturn denials.  

This position is hybrid and will require on-site presence in Hunt Valley, MD once per month.

The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state's future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System's anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.

Education

• High School Diploma or equivalent (GED)
• Experience
• Two years’ work experience in 1) denials/appeals processing or utilization review; 2) collection or accounts receivable follow up; or 3) tech/medical secretary in acute care setting

Preferred

Education

• Associates Degree
• Experience
• Three-to-five years’ experience in denials/appeals processing.

All your information will be kept confidential according to EEO guidelines.

 Compensation

• Pay Range: $19.5-$27.31
• Other Compensation (if applicable):
• Review the 2024-2025 UMMS Benefits Guide