DENIALS MANAGEMENT SPECIALIST – BUSINESS SERVICES

Lewes, Delaware,     Summary: Leads and oversees the denial management processes for the Commercial Payer Team.   Other information: Minimum of two years of healthcare billing/collections or claims processing. Must be familiar with medical terminology, ICD9/ICD10 and CPT coding. Knowledge of managed care reimbursement methods, medical terminology, medical and healthcare billing and collections. Excellent analytical, organizational, and computer skills. Ability to communicate with public in a professional and courteous manner.   Responsibilities: Leads the denial management processes for the Commercial Payer Team. Prioritizes workflow, assigns duties, provides instruction and training, and monitors and reviews work to ensure high levels of productivity and quality. Analyzes and validates commercial denials. Researches denial criteria and compares to payer contract and benefits for appropriateness.

Functions as liaison with clinical departments regarding denials. Provides formal and/or informal education to departments in an effort to reduce or eliminate denials. Provides weekly reports to department managers/designees of denial activity, and coordinates appeal decisions and supporting documentation. Initiates administrative appeals, to include writing appeal letters, and provides administrative support for medical necessity appeals. Recognizes and reports payer denial trends and issues to management, and makes recommendations for changes to reduce or eliminate denials. Recognizes, trends, and reports internal billing or coding issues resulting in denials. Possesses the ability to present information and recommendations accurately and effectively. Provides clear, concise, and timely documentation in the patient accounting computer system. Performs timely follow-up to appeals and responses from departments. Demonstrates proficiency with the following computer systems and applications: Patient Accounting, Microsoft Word, Document Imaging, Claims Editor, and RAS.

Is proficient in navigating through payer web sites.     Competencies and skills: Essential:
* Knowledge Of Office Equipment
* Clear Communication Skills Both Written And Verbal
* Knowledge Of Basic Computer Programs
* Able To Keep Confidential Information Regarding Patients, Team Members
* Able To Withstand Crisis Situations
* Has Skills To Provides Customer Service To Patients, Team Members And Visitors
* Experience With Excel, Power Point, Word, Visio, Etc.   Education: Essential:
* High school graduate or equivalent        L ocation: Hospital-Main Campus   Shift : 8am-4:30pm Monday – Friday   FTE: 1. 000000     Work Status: Full Time                

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