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Revenue Specialist

3 months ago

Grand Junction, United States Community Hospital Full time
The Job: The Denials Specialist manages multiple revenue improvement activities and is responsible for performance and overall management of the denials/appeals process.

Work Schedule: PRN

Location: Community Hospital

Responsibilities:

  • Manages and develops necessary department and executive level reporting on pay or and denial trends.
  • Chair the Denials Committee. Develop short term and long-term actions plans to ensure processes are developed or changed to prevent ongoing payment issues.
  • Actively participates in meetings and/or seminars and disseminates denial reports and information to peers to enhance the knowledge and skills of the department.
  • Review and research denials that received as no payment/previous submitted claims with no response for all pay or/and service areas.
  • Identifies root cause of the denial and addresses/report the denial issue with the appropriate pay or internal department and supervisor. Meets with Department Directors and outside offices frequently to create processes for improvement.
  • Administrator for Craneware and Hospital Charges - Trains department Directors regarding Craneware. Manages and approves all charges and existing charges. Assists the Chargemaster Committee in defining and developing new charges.
  • Complies with adjustment and appeal or reconsideration in conjunction with the Coding and Reimbursement guidelines.
  • Completes and requests adjustments to claims, as appropriate, based on the dollar threshold of the adjustment.
Requirements:
  • Associate's degree in finance, business or related field with at least two (2) years of billing experience including at least one (1) year of denials/appeals experience; or equivalent combination of education and experience.


This position's hiring pay range is: $29.00 - $33.35 per hour, depending on education and experience.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)