Denials Administrative Specialist Remote (see full posting for eligible states)
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Job Location:
Flagstaff, AZ - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Overview
NAH reserves the right to make hiring decisions based on applicants state of residence if outside the state of Arizona. NAH currently hires for remote positions in the following states:
- Alabama
- Arizona
- Florida
- Georgia
- Idaho
- Indiana
- Kansas
- Michigan
- Missouri
- North Carolina
- Ohio
- Oklahoma
- Pennsylvania
- South Carolina
- Tennessee
- Texas
- Virginia
Under the direction of the Director of Care Management the Denials Administration Specialist is responsible for assisting the Nurse Denials Specialist in managing patient medical denials through the request of documentation and assistance to prepare cases for presentation and evaluation. S/he provides additional assistance in tracking and monitoring cases on spreadsheets to track denials and reimbursements. The Denials Administration Specialist will partner with the utilization care management revenue cycle physician advisor CDI and health management teams.
Responsibilities
Revenue Management * Review and compile required denials documentation and submit in a timely manner to ensure payment. * Track and document tasks in Midas to assist Nurse Denials Specialist in preparing and following up on cases. * Assist in preparing documentation for appeal letters. * Track and monitor concurrent and retrospective cases on denials spreadsheets. * Assist in auditing for concurrent reviews admission status coding DRG and outpatient denials management. |
Denials and Appeals Management * Assist in gathering data for performance of retrospective denials. * Gather data and documentation to assist the Nurse Denials Specialist and the Physician Advisor in review of clinical denials. * Request necessary documentation from physicians offices for denials cases. * Assist with paperwork and follow up of self-denials cases Code 44s and Noridian appeal cases. |
Health Management * Track and monitor audits of clinical information from payers governmental agencies etc. * Provide outreach and assistance to other support staff within the department when absent or in need of additional support of their work. |
Compliance/Safety * Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner. * Stays current and complies with state and federal regulations/statutes and company policies that impact the employees area of responsibility. * If required for the position ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates. * Completes all company mandatory modules and required job-specific training in the specified time frame. |
Qualifications
| Education |
| Experience |
Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers and competence in using computers and basic software programs.
Required Experience:
IC
Key Skills
- Business Intelligence
- Car Driving
- Analysis
- Android
- Fireworks
About Company
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