Denials Specialist Full Time 40 hours

$5000 Sign on Bonus Eligible!

At Bristol Health we begin each day caring today for your tomorrow. We have been an integral part of our community for the past 100 years. We are dedicated to providing the best possible care and service to our patients residents and families. We are committed to provide compassionate quality care at all times and to uphold our values of Communication Accountability Respect and Empathy (C.A.R.E.. We are Magnet and received the 2020 Press Ganey Leading Innovator award for our rapid adoption and implementation of healthcare solutions during the COVID19 pandemic. Use your expertise compassion and kindness to transform the patient experience. Make a difference. Make Bristol Health your choice.

The Denials Specialist will be responsible for researching analyzing resolving and trending rejections and/or denials specific to the revenue cycle. This includes but is not limited to analyzing specific denial categories and codes researching the underlying reason for the denial rectifying the issue in the patient management system and ensuring that the claim is adjudicated.

The Denials Specialist should be able to identify potential process improvement opportunities and offer recommendations for correcting these issues. The Denials Specialist will be responsible for understanding how all of the various components of the revenue cycle can potentially cause a denial and possible solutions that may result from the interaction of these components. The Denials Specialist will have to be a problem solver and possess the ability to use the resources available to rectify a denial.

The Denials Specialist should be able to analyze Managed Care contracts and reconcile payments received. Contact insurance companies to have adjustments processed and/or file appeals if payments are not in accordance with the contract. The Denials Specialist will have direct interaction with all Managers and/or Department Heads regarding administrative issues related to rejections and/or denials.

Responsibilities:

Focus on working complex denials across multiple payers and/or regions

Conduct account history research as required including navigating patient encounters and charts researching charge and payment histories determininghistoric account and claim status changes and researching the payer remittance advice

Conduct follow up research on claims to review contract discrepancy and account balances. This may include attaching documentation amending overage/patient/encounter/provider/facility data gathering additional information requests and resubmitting corrected claims to ensure accurate and timely claim adjudication

Defend and appeal denied claims including researching underlying root cause collecting required information or documents adjusting the account as necessary resubmitting claims and all appropriate follow up activities thereafter to ensure adjudication of the claim.

Must also be comfortable communicating denial root cause and resolution to leadership as needed. Responsible for aggregating the data that is required and then sending complete appeal packets for every level of appeal either by mail fax or secured email.

Identify system loading discrepancies within the contract management system and refer to the Supervisor and/or Contract Associate Director for correction

Adhere to Compliance Plan and to all rules and regulations of all applicable local state and federal agencies and accrediting bodies

Actively participate in outstanding customer service and accept responsibility in maintaining relationships that are equally respectful to all

Review and resolve accounts assigned via work lists daily as directed by management.

Tracking and trending of rejection/denial issues.

Recommendation of alternative contracting rates/terms with the goal to improve net revenue and/or ease the administrative burden associated with the contract terms.

Meeting with payers to review methodology and assist in the determination of counterproposals or settlement resolution.

Supporting the Manager and Director as needed.

Minimum Requirements:

High school diploma or equivalent

Five (five) or more years of experience in billing A/R follow up denials management & appeal writing

Skill Set Requirement:

Proficient in payment review systems hospital information systems and coding methodologies.

Strong quantitative analytical and organizational skills.

Advanced understanding of an Explanation of Benefits (EOB)

Intermediate knowledge of CPT ICD10 and HCPCS coding standards

Understand CMS Memos and Transmittals.

Understand medical records professional claims and the Charge master.

Utilize and understand computer technology.

Understand all ancillary charges and multispecialty departmental functions.

Communicate orally and in written form.

Understand insurance terms and payment methodologies.

Work with physicians administrative staff and department managers effectively.

Identify accurate Revenue code(s) CPT codes and HCPCS codes for services/items.

Identify clerical error mistakes in interpretation imprecise records and inaccurate

service code assignment.

Perform reviews for appropriateness of coding and charging including business

office activities systems function and charging methodologies.

Additional Skill Set Requirement:

Strong Understanding of the interrelationships of the Revenue Cycle Departments

Strong Understanding of Patient Financial Information System and Billing System

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities duties and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time as needed.