Denials Management Rep

Job Summary:

Review all denials, obtain additional information as needed and files necessary appeals to resolve payor denials. Forward claim denials to appropriate departments when additional information is needed, i.e., Health Information Management, Case Management, etc.

ESSENTIAL FUNCTIONS:

* Monitor Advanced Beneficiary Notices and denials as it relates to medical necessity requirements.
* Identify and evaluate denials to determine specific issues and patterns that need to be addressed with the facility and clinics.
* Investigate all payer denials and take appropriate action including but not limited to appeals, corrected billing and chart reviews.
* Document patient accounting system with all denial activity and actions taken.
* Compile monthly denial reports.
* Maintain all data elements related to denials in various monitoring systems.
* Other duties as assigned by supervisor.

ADDITIONAL RESPONSIBILITIES:

KNOWLEDGE/SKILL/ABILITIES:

* Must be able to communicate effectively with strong attention to details and problem solving both verbally and written.
* Strong telephone communications skills are required.
* Ability to prioritize work and meet deadlines is required.
* Knowledge of general office procedures is required.
* Ability to operate common computer systems, utilize hospital collection system and business software is required.
* Must be self motivated.
* Reasoning Ability: Ability to define problems, collect data, validate data, establish facts, and draw valid conclusions.
* Computer Skills: To perform this job successfully, an individual should have intermediate level knowledge of Microsoft Office Tools as well as the hospital patient accounting systems.
* Strong analytical skills

AGE-RELATED COMPETENCIES: Demonstrates the basic knowledge and skills necessary to identify age-specific patient needs appropriate for this position.

Information Management: Treats all information and data within the scope of the position with appropriate confidentiality and security.

Risk Management/Quality Management/Safety: Cooperates fully in all Risk Management, Quality Management, and Safety Activities and Investigations.

MINIMUM POSITION QUALIFICATIONS:

* Education-High school diploma/GED
* Work Experience-3-5 years experience in a Health Care Business Office.
* Training-none
* License/Certification-none