Denials Management Specialist

Where compassion meets innovation and technology and our employees are family.

Job Title : Denials Management Specialist

General Purpose of Job :

Under direct supervision, the Denials Management Specialist will be the first contact in accounts and determine where they go next in the denial’s process / review. They will also assist with the Billing, Follow-Up, Collection, Root Causing, Recovery, and Reporting of assigned Insurance or Self-Pay claims. Applying a scientific approach, to include research and analysis, the Denials Management Specialist will also occasionally assist with the discovery of denials or denial trends and offer recommendations for solutions as a denial preventive.

Essential Duties and Responsibilities :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and / or hospital administration as required.

• Review each account in que and determine appropriate next steps, then categorize denials for team to review and act on.
• Ability to scrub account and move account forward for proper adjudication.
• Able to read and understand an EOB.
• Identify process errors in the organizational system or teams and assist in creating ways to limit them from occurring.
• Maintains utmost level of confidentiality at all times.
• Adheres to hospital policies and procedures.
• Committed to professional development.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Occasionally assist with the Billing, Follow-Up, Collection, Root Causing, Recovery, and Reporting of assigned Insurance or Self-Pay claims.
• Occasionally assist in filing appeals as appropriate to resolve payer denials and work with payers to monitor appeals in process.
• Occasionally assist with other team members in functions to ensure work queues are below set threshold.
• Consistently meet productivity and quality standards.
• Assure patient privacy and confidentiality as appropriate or required.
• Maintain professional relationships and convey relevant information to other members of the healthcare team, and within the facility.
• Other duties as assigned.

Supervisory Responsibilities :

Effectively administers performance management system including :

Education and / or Experience :