Denial Specialist

Northern Light Eastern Maine Medical Center

Department: Cancer Care - Brewer

Position is located: Lafayette Building

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: No Hours Assigned

Summary :

This position is responsible for resolving the denials by all applicable payers of the Patient Account Services in a Centralized Business Office environment. This position is responsible for resolving denials in accordance with regulatory and contractual obligations. This position requires a thorough understanding of the requirements of the Government and Non-Government payment policies and payer contracts. In addition, this position is held accountable to adhere to the policies, procedures, and applicable laws; including metrics related to productivity and quality. This position works closely with a team of Denial Resolution Specialists to analyze and take corrective action on payer denials to ensure an optimum revenue cycle workflow.

Responsibilities :

• Actively participate in team huddles and meetings by way of sharing knowledge, requesting information, and recommending process improvements.
• Work closely by way of problem solving with peers and leaders to address payer denial and processing issues or changes that directly impact the accounts receivable.
• Resolve assigned accounts in a timely and accurate manner, which maximizes reimbursement in compliance with payer regulations and the department’s policy and procedures.
• Take necessary AR adjustments in accordance with the department’s adjustment policy.
• Meet or exceed the organization performance standards as it relates to quality and productivity.
• Reviews, analyzes, and initiates appropriate action for complex denial resolution.
• Reviews applicable payer policies to determine accuracy of denial.
• Resolve payment disputes with payers by following appeal protocols and processes.
• Request relevant information from appropriate revenue cycle and clinical departments as required by payer.
• Advises management of payer processing issues which may require attention in a timely manner.
• Ensure all functions related to denials support the team goals and objectives as well as EMHS’s financial performance objectives.
• Thoroughly understand the department’s key performance indicators.
• Maintain the knowledge of payer policies; complete AAHAM or other healthcare related webinars.
• Attend internal education sessions to enhance or gain new skills.
• Demonstrate departmental desire to provide community benefits by way of charitable events or contribution outside the four walls of the department.

Other Information :

Competencies and Skills

• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Education

• Required High School Diploma/General Educational Development (GED)

Working Conditions

• Potential exposure to diseases or infections.
• Work with computers, typing, reading or writing.
• Lifting, moving and loading less than 20 pounds.
• Prolonged periods of sitting.