Aultman Health Foundation
OUTPATIENT CLINICAL DENIALS SP
Aultman Health Foundation - East Canton, Ohio, United States, 44730
Work at Aultman Health Foundation
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Overview
Join to apply for the
OUTPATIENT CLINICAL DENIALS SP
role at
Aultman Health Foundation 3 weeks ago Be among the first 25 applicants Join to apply for the
OUTPATIENT CLINICAL DENIALS SP
role at
Aultman Health Foundation Position Summary
The Denials Specialist performs advanced level work related to denial management. The individual is responsible for managing denials by conducting a comprehensive review of the account documentation. The Specialist will write compelling arguments based on denial reasons and medical policies of the payor and submit the appeal/dispute in a timely manner. Position Summary
The Denials Specialist performs advanced level work related to denial management. The individual is responsible for managing denials by conducting a comprehensive review of the account documentation. The Specialist will write compelling arguments based on denial reasons and medical policies of the payor and submit the appeal/dispute in a timely manner.
The position identifies and works to resolve problems to ensure accurate and complete billing and educates staff on proper billing, follow-up, and documentation practices. Additionally, this position will actively manage, maintain, and communicate denial/appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle Management.
The position anticipates and responds to a wide variety of issues/concerns. This role is key to securing reimbursement and minimizing organizational write off.
This position is partially remote.
Primary Responsibilities & Requirements
Research payer denials resulting in delays in payment. Submit detailed, customized appeals to payers based on review and in accordance with Medicare, Medicaid, and third-party guidelines Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution Review payor communications, identifying risk for loss reimbursement related to medical policies; escalates potential issues to stakeholders as appropriate Understand and maintain a knowledge of regulations regarding billing and reimbursement. Maintain Customer Service Standards: Support co-workers and engage in positive interactions. Communicate professionally and timely with internal and external customers Demonstrate friendliness by smiling and making eye contact when greeting all customers. Provide helpful assistance in anticipating and responding to the needs of our customers. Maintain attendance (including tardiness) in accordance with departmental standards. Complete annual competencies as required by Aultman Hospital.
Desired Job Qualifications/Skill Sets
Billing experience in a Physician Office or Hospital setting helpful Experience in hospital reimbursement helpful Ability to react to frequent changes in duties and volume of work Effective communication skills Extensive writing capabilities / efficiencies Knowledge of local, state and federal healthcare regulations Knowledge of Medicare, Medicaid and third-party reimbursement methodologies Ability to manage multiple tasks with ease and efficiency Self-starter with a willingness to try new ideas Ability to work independently and be result oriented Positive, can-do attitude coupled with a sense of urgency Effective interpersonal skills, including the ability to promote teamwork Solid computer skills (Excel, PowerPoint, Access, internet, Medipac, FinThrive, Cerner) Maintain confidentiality of sensitive information
Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
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OUTPATIENT CLINICAL DENIALS SP
role at
Aultman Health Foundation 3 weeks ago Be among the first 25 applicants Join to apply for the
OUTPATIENT CLINICAL DENIALS SP
role at
Aultman Health Foundation Position Summary
The Denials Specialist performs advanced level work related to denial management. The individual is responsible for managing denials by conducting a comprehensive review of the account documentation. The Specialist will write compelling arguments based on denial reasons and medical policies of the payor and submit the appeal/dispute in a timely manner. Position Summary
The Denials Specialist performs advanced level work related to denial management. The individual is responsible for managing denials by conducting a comprehensive review of the account documentation. The Specialist will write compelling arguments based on denial reasons and medical policies of the payor and submit the appeal/dispute in a timely manner.
The position identifies and works to resolve problems to ensure accurate and complete billing and educates staff on proper billing, follow-up, and documentation practices. Additionally, this position will actively manage, maintain, and communicate denial/appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle Management.
The position anticipates and responds to a wide variety of issues/concerns. This role is key to securing reimbursement and minimizing organizational write off.
This position is partially remote.
Primary Responsibilities & Requirements
Research payer denials resulting in delays in payment. Submit detailed, customized appeals to payers based on review and in accordance with Medicare, Medicaid, and third-party guidelines Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution Review payor communications, identifying risk for loss reimbursement related to medical policies; escalates potential issues to stakeholders as appropriate Understand and maintain a knowledge of regulations regarding billing and reimbursement. Maintain Customer Service Standards: Support co-workers and engage in positive interactions. Communicate professionally and timely with internal and external customers Demonstrate friendliness by smiling and making eye contact when greeting all customers. Provide helpful assistance in anticipating and responding to the needs of our customers. Maintain attendance (including tardiness) in accordance with departmental standards. Complete annual competencies as required by Aultman Hospital.
Desired Job Qualifications/Skill Sets
Billing experience in a Physician Office or Hospital setting helpful Experience in hospital reimbursement helpful Ability to react to frequent changes in duties and volume of work Effective communication skills Extensive writing capabilities / efficiencies Knowledge of local, state and federal healthcare regulations Knowledge of Medicare, Medicaid and third-party reimbursement methodologies Ability to manage multiple tasks with ease and efficiency Self-starter with a willingness to try new ideas Ability to work independently and be result oriented Positive, can-do attitude coupled with a sense of urgency Effective interpersonal skills, including the ability to promote teamwork Solid computer skills (Excel, PowerPoint, Access, internet, Medipac, FinThrive, Cerner) Maintain confidentiality of sensitive information
Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
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