Brown University Health
Denials Specialist – Brown University Health
Join Brown University Health as a Denials Specialist and play a key role in maximizing reimbursement from contracted payers by analyzing, tracking, and trending denials.
Responsibilities
Evaluate denied accounts sent to the Denials Management Department for review and assign to appropriate work queues.
Identify repetitive issues, run reports, and follow up with departments to ensure timely resolution.
Review denial database reports to categorize provider liable denials, root causes, and resolution.
Maintain end‑of‑month reviews of the denial database to identify trends and report on opportunities.
Develop and maintain strong working relationships with hospital departments and referring physician offices to support appeal/reversal processes.
Keep current knowledge of state and federal regulations, accreditation, and compliance requirements and payer specific policies.
Research payer issues, prepare monthly payer update reports, and present during monthly Appeal/Denial meetings.
Track status of appeals, maintain organized records, and meet established timelines.
Process LifeChart online adjustments related to appeals within scope of job function.
Continuously evaluate workflow and identify opportunities for process improvement to achieve full payment.
Generate ad hoc reports as requested by Manager to assist daily operations.
Qualifications
Associate’s degree in accounting, business office practices, computer science, or related field, or equivalent experience.
Three to five years of experience in hospital patient accounting with thorough knowledge of claims administration.
Experience with ICD‑9/10, CPT‑4 coding, UB‑04 and HCFA 1500 claims administration.
Ability to perform financial analysis and understand regulatory requirements.
Location & Work Type BHCS 15 LaSalle Square – Providence, RI, 02903. Full‑time, M‑F 7:00 am‑3:30 pm, daytime shift, 8 hours per day.
EEO Statement Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.
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Responsibilities
Evaluate denied accounts sent to the Denials Management Department for review and assign to appropriate work queues.
Identify repetitive issues, run reports, and follow up with departments to ensure timely resolution.
Review denial database reports to categorize provider liable denials, root causes, and resolution.
Maintain end‑of‑month reviews of the denial database to identify trends and report on opportunities.
Develop and maintain strong working relationships with hospital departments and referring physician offices to support appeal/reversal processes.
Keep current knowledge of state and federal regulations, accreditation, and compliance requirements and payer specific policies.
Research payer issues, prepare monthly payer update reports, and present during monthly Appeal/Denial meetings.
Track status of appeals, maintain organized records, and meet established timelines.
Process LifeChart online adjustments related to appeals within scope of job function.
Continuously evaluate workflow and identify opportunities for process improvement to achieve full payment.
Generate ad hoc reports as requested by Manager to assist daily operations.
Qualifications
Associate’s degree in accounting, business office practices, computer science, or related field, or equivalent experience.
Three to five years of experience in hospital patient accounting with thorough knowledge of claims administration.
Experience with ICD‑9/10, CPT‑4 coding, UB‑04 and HCFA 1500 claims administration.
Ability to perform financial analysis and understand regulatory requirements.
Location & Work Type BHCS 15 LaSalle Square – Providence, RI, 02903. Full‑time, M‑F 7:00 am‑3:30 pm, daytime shift, 8 hours per day.
EEO Statement Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.
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