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Job Title: Denials Management Specialist

General Purpose of Job:

Under direct supervision, the Denials Management Specialist will be the first contact in accounts and determine where they go next in the denial’s process/review. They will also assist with the Billing, Follow-Up, Collection, Root Causing, Recovery, and Reporting of assigned Insurance or Self-Pay claims. Applying a scientific approach, to include research and analysis, the Denials Management Specialist will also occasionally assist with the discovery of denials or denial trends and offer recommendations for solutions as a denial preventive.

Essential Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.

• Review each account in que and determine appropriate next steps, then categorize denials for team to review and act on.
• Ability to scrub account and move account forward for proper adjudication.
• Able to read and understand an EOB.
• Identify process errors in the organizational system or teams and assist in creating ways to limit them from occurring.
• Maintains utmost level of confidentiality at all times.
• Adheres to hospital policies and procedures.
• Committed to professional development.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Occasionally assist with the Billing, Follow-Up, Collection, Root Causing, Recovery, and Reporting of assigned Insurance or Self-Pay claims.
• Occasionally assist in filing appeals as appropriate to resolve payer denials and work with payers to monitor appeals in process.
• Occasionally assist with other team members in functions to ensure work queues are below set threshold.
• Consistently meet productivity and quality standards.
• Assure patient privacy and confidentiality as appropriate or required.
• Maintain professional relationships and convey relevant information to other members of the healthcare team, and within the facility.
• Other duties as assigned.

Supervisory Responsibilities:

Effectively administers performance management system including:

• developmental feedback
• goal setting
• assesses competency
• progressive discipline
• Strong knowledge of and effective in administering hospital policies and procedures.
• Responsible for sound management of human resources.
• Makes and implements decisions compatible with organizational goals.
• Maintains composure, effectiveness, and flexibility under pressure.

Education and/or Experience:

• Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience.
• Minimum of one year healthcare experience in a healthcare setting.
• Outstanding analytical ability and financial skills.
• Experience with denials preferred. Understanding of payers, and coding experience preferred.
• Working knowledge of managed care operations and practices preferred.
• Working knowledge of health system admitting, billing, and utilization review as well as physician office practices, physician credentialing and physician billing practices preferred. Effective communication, organization, and interpersonal skills essential.
• Work independently.
• Excellent oral and written communication skills.
• PC skills necessary with experience in Microsoft Office products, including PowerPoint.
• English Language Skills