New Job Denials And Appeals Specialist In Delaware

Kent Campus Hospital

STATUS: Full Time 80 Hours

SHIFT: Days

GENERAL SUMMARY:

Summary:
The specialist is responsible for reviewing and processing of charges as well as researching and appealing denied claims. The Specialist must effectively interact with multiple disciplines including Patient Access, Hospital Information Management, Contract management, patient Financial Services, physicians, private insurance and government agencies. The Specialist demonstrates self-direction, professionalism, effective communication skills, a working knowledge of denials, and an expertise in understanding private and governmental regulations as it applies to physician office services.

ESSENTIAL FUNCTIONS & ACCOUNTABILITIES:

1. Review and process charges to help ensure clean claims and invoices. Contact providers and clinical staff with any questions to process charges correctly.
2. Work follow-up work queues to process denials on a daily basis, resubmitting claims and writing appeals as appropriate based on the denial. Completion of necessary payer reconsideration forms. Recording of identified issues into payer issue logs/spreadsheets.
3. Timely follow-up/communication with payer on appeals submitted until a final resolution has been reached.
4. Monitor and track submitted appeals; monitors reduction of denial volume and reduction of backlog of non-reconciled denials.
5. Based on the nature of the denials, determine potential root causes, flag/track repetitive issues and communicate progress to management on a monthly basis. Identification of departmental process/procedure improvements and/or education as needed to address prospective denials avoidance.
6. Strong working knowledge of payer contracts and Federal program claim submission guidelines.
7. Perform registration and scheduling duties to be able to participate in process improvement on a routine basis.
8. Perform cash posting and reconciliation for Occupational Health.
9. All other duties as assigned within the scope and range of job responsibilities

REQUIRED MINIMUM EDUCATION AND CREDENTIAL:

• Education Associate Degree
  
  or four years of patient accounting experience.
  
• Credential

EXPERIENCE:

Required: Four years hospital/physician office patient Accounting including billing, collections, ins authorization and A/R Preferred: Five years hospital/physician office billing or collections experience. Prior written clinical appeal experience.

PREFERRED EDUCATION AND CREDENTIAL:

• Education Bachelor Degree
  Bachelor Degree
  BUSINESS
  Finance
  
  
  
  
• Credential Certified Patients Account Manager
  
  
  

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