Lifespan
SUMMARY: The Denial Appeal Representative reports to the Patient Financial Services Technical Appeals Supervisor. Under general direction and within established Brown University Health policies and procedures, performs all administrative/clerical support duties needed to maximize reimbursement from contracted payers. Executes the appeal process by receiving, assessing, documenting, tracking, analyzing, responding to, and/or resolving appeals with third‑party payers. Uses available resources to analyze, track, and trend denials throughout the workflow. Processes a thorough understanding of the denials and appeals process and the ability to work denials and appeals as needed, within the scope of job function. Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers, and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done: Instill Trust and Value Differences; Patient and Community Focus and Collaborate.
RESPONSIBILITIES
Provides administrative/clerical support to the denials appeals process which includes receiving, assessing, documenting, tracking, responding to, and/or resolving denials with third‑party payers in a timely fashion.
Processes and organizes a large volume of record requests, document scanning, telephone calls, and electronic record documentation requirements.
Evaluates denied accounts sent to the Denials Management Department for review.
Assigns denied accounts to appropriate department work queues for resolution.
Identifies repetitive issues with the goal of finding preventative solutions.
Uses reports and work queues to identify accounts not worked in a timely manner and follows up with clinical and financial departments when this occurs.
Tracks the status and progress of appealed activity and payer appeal responses using work queues and well‑organized records to assure established timelines are met.
Researches payer issues and recommends changes as appropriate.
Reviews monthly payer updates that will be reported during the monthly Appeal/Denial meeting.
Maintains a strong collegial working relationship with payers to assure claims/appeals are processed appropriately.
Processes necessary LifeChart online adjustments or changes related to appeals as needed, within scope of job function.
Continually evaluates workflow and identifies opportunities to improve process for full and complete payment for all hospital services rendered to patients, including the need for system updates after careful analysis.
Creates, generates, and maintains ad‑hoc reports as requested by manager to assist in the daily operation of the department.
Participates in staff meetings, councils, quality improvement teams, and other meetings and committees as required.
Develops and maintains working relationship with Brown University Health affiliate departments as needed to ensure full data exchange.
Performs other duties as necessary.
WORK LOCATIONS / EXPECTATIONS After orientation at the Corporate facilities, work is performed based on the following options approved by management and within adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure:
Full‑time schedule worked in office ;
Full‑time schedule worked in a dedicated space in the home ;
Part‑time schedule in office and in a dedicated space within the home . This is a hybrid role requiring a minimum of 2 days per week in the office. Schedules must be approved in advance by management and allow for flexibility that does not interfere with the ability to accomplish all job functions. Staff must participate in scheduled meetings and be available to management throughout their scheduled hours, remain signed into Microsoft Teams during their entire shift, and communicate with supervisor as directed. Performs other duties as assigned.
MINIMUM QUALIFICATIONS Education:
High School Graduate or equivalent.
Experience:
Experience and knowledge in hospital patient accounting or denial appeals in a similarly complex healthcare organization is preferred. Must be familiar with the use of computers and Microsoft Office tools. Ability to perform financial analysis preferred. Comprehensive knowledge of patient accounting activities in an automated, networked, multiple hospital environment preferred. Detailed knowledge of regulatory requirements preferred. Demonstration of highly developed organizational ability, communication skills, and problem‑solving skills.
Supervisory Responsibility:
None.
PAY RANGE $20.55 – $33.93
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.
LOCATION BHCS 15 LaSalle Square – Providence, Rhode Island 02903
WORK TYPE Monday–Friday 7:00 am – 3:30 pm
WORK SHIFT Day
DAILY HOURS 8 hours
DRIVING REQUIRED No
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RESPONSIBILITIES
Provides administrative/clerical support to the denials appeals process which includes receiving, assessing, documenting, tracking, responding to, and/or resolving denials with third‑party payers in a timely fashion.
Processes and organizes a large volume of record requests, document scanning, telephone calls, and electronic record documentation requirements.
Evaluates denied accounts sent to the Denials Management Department for review.
Assigns denied accounts to appropriate department work queues for resolution.
Identifies repetitive issues with the goal of finding preventative solutions.
Uses reports and work queues to identify accounts not worked in a timely manner and follows up with clinical and financial departments when this occurs.
Tracks the status and progress of appealed activity and payer appeal responses using work queues and well‑organized records to assure established timelines are met.
Researches payer issues and recommends changes as appropriate.
Reviews monthly payer updates that will be reported during the monthly Appeal/Denial meeting.
Maintains a strong collegial working relationship with payers to assure claims/appeals are processed appropriately.
Processes necessary LifeChart online adjustments or changes related to appeals as needed, within scope of job function.
Continually evaluates workflow and identifies opportunities to improve process for full and complete payment for all hospital services rendered to patients, including the need for system updates after careful analysis.
Creates, generates, and maintains ad‑hoc reports as requested by manager to assist in the daily operation of the department.
Participates in staff meetings, councils, quality improvement teams, and other meetings and committees as required.
Develops and maintains working relationship with Brown University Health affiliate departments as needed to ensure full data exchange.
Performs other duties as necessary.
WORK LOCATIONS / EXPECTATIONS After orientation at the Corporate facilities, work is performed based on the following options approved by management and within adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure:
Full‑time schedule worked in office ;
Full‑time schedule worked in a dedicated space in the home ;
Part‑time schedule in office and in a dedicated space within the home . This is a hybrid role requiring a minimum of 2 days per week in the office. Schedules must be approved in advance by management and allow for flexibility that does not interfere with the ability to accomplish all job functions. Staff must participate in scheduled meetings and be available to management throughout their scheduled hours, remain signed into Microsoft Teams during their entire shift, and communicate with supervisor as directed. Performs other duties as assigned.
MINIMUM QUALIFICATIONS Education:
High School Graduate or equivalent.
Experience:
Experience and knowledge in hospital patient accounting or denial appeals in a similarly complex healthcare organization is preferred. Must be familiar with the use of computers and Microsoft Office tools. Ability to perform financial analysis preferred. Comprehensive knowledge of patient accounting activities in an automated, networked, multiple hospital environment preferred. Detailed knowledge of regulatory requirements preferred. Demonstration of highly developed organizational ability, communication skills, and problem‑solving skills.
Supervisory Responsibility:
None.
PAY RANGE $20.55 – $33.93
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.
LOCATION BHCS 15 LaSalle Square – Providence, Rhode Island 02903
WORK TYPE Monday–Friday 7:00 am – 3:30 pm
WORK SHIFT Day
DAILY HOURS 8 hours
DRIVING REQUIRED No
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