Position Summary

This position is primarily responsible for documenting, categorizing, trending, and providing a root cause analysis of denials and underpayments received by payors. Works collaboratively with key team members to initiate appeals process and follow up on receipt and outcome of appeals. Also responsible for assisting with the development of the denial management team action plans, taking corrective action to receive proper payment for services rendered, and reporting and summarizing findings and outcomes in a timely manner.  Works collaboratively with other departments to seek proper reimbursement for those services rendered. This person requires excellent interpersonal skills and the ability to work with minimal supervision.

Work Schedule

Monday through Friday regular business hours, or as special assignments dictate.

Primary Duties

• Identify and accumulate denied claims.
• Document denial and payment related data into the hospital’s denial management system.
• Analyze and document the root cause of denials and underpayments.
• Coordinate with Revenue Cycle team in resolving denials and underpayments.
• Appeal claims as appropriate and filter other claims to the appropriate hospital staff members for claim resolution.
• Update patient account record to identify actions taken on the account.
• Serve as liaison with third-party payers/agencies regarding appeals to ensure optimal reimbursement and any other billing/payment issues or questions are resolved.
• Continuously monitor denied claims throughout the denials management process to ensure claim resolution is achieved.
• Ensure adjustment requests are prepared correctly and submitted in a timely manner for denied claims that need to be written off.
• Work closely with Revenue Cycle team and other hospital departments to assist with identification of root cause of denials and development of process improvements to significantly reduce denials.
• Serve as an educational resource for hospital staff to reduce or eliminate denials.
• Prepare accurate statistical and other reports as directed.
• Summarize and report findings and outcomes in a timely manner.
• Assist in developing recommendations to maintain efficient and effective denial management processes.
• Perform other duties as directed to provide the most efficient service to the hospital/clinic in a manner which supports the overall effectiveness for the department and the hospital/clinic.

Qualifications/Specifications

• Education: High school degree or equivalent.
• Licensure/Certification: None required.
• Experience: Minimum two years financial experience required. Hospital and/or medical office experience preferred.