What are the responsibilities and job description for the OUTPATIENT CLINICAL DENIALS SP position at Aultman Health Foundation?
Job Description
Denials Specialist
Department: 16004/HDS Payer Management & Analytics
Position: Denials Specialist
Reports To: Assistant Manager/ Executive Director Health Information
Position Summary
The Denials Specialist performs advanced level work related to denial management. The individual is responsible for managing denials by conducting a comprehensive review of the account documentation. The Specialist will write compelling arguments based on denial reasons and medical policies of the payor and submit the appeal/dispute in a timely manner.
The position identifies and works to resolve problems to ensure accurate and complete billing and educates staff on proper billing, follow-up, and documentation practices. Additionally, this position will actively manage, maintain, and communicate denial/appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle Management.
The position anticipates and responds to a wide variety of issues/concerns. This role is key to securing reimbursement and minimizing organizational write off.
This position is partially remote.
- Research payer denials resulting in delays in payment.
- Submit detailed, customized appeals to payers based on review and in accordance with Medicare, Medicaid, and third-party guidelines
- Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution
- Review payor communications, identifying risk for loss reimbursement related to medical policies; escalates potential issues to stakeholders as appropriate
- Understand and maintain a knowledge of regulations regarding billing and reimbursement.
- Maintain Customer Service Standards:
- Support co-workers and engage in positive interactions.
- Communicate professionally and timely with internal and external customers
- Demonstrate friendliness by smiling and making eye contact when greeting all customers.
- Provide helpful assistance in anticipating and responding to the needs of our customers.
- Maintain attendance (including tardiness) in accordance with departmental standards.
- Complete annual competencies as required by Aultman Hospital.
Desired Job Qualifications/Skill Sets
- Billing experience in a Physician Office or Hospital setting helpful
- Experience in hospital reimbursement helpful
- Ability to react to frequent changes in duties and volume of work
- Effective communication skills
- Extensive writing capabilities / efficiencies
- Knowledge of local, state and federal healthcare regulations
- Knowledge of Medicare, Medicaid and third-party reimbursement methodologies
- Ability to manage multiple tasks with ease and efficiency
- Self-starter with a willingness to try new ideas
- Ability to work independently and be result oriented
- Positive, can-do attitude coupled with a sense of urgency
- Effective interpersonal skills, including the ability to promote teamwork
- Solid computer skills (Excel, PowerPoint, Access, internet, Medipac, FinThrive, Cerner)
- Maintain confidentiality of sensitive information
