Denial Management Specialist

EvergreenHealth•Kirkland, WA

29d•$29 - $46•Remote

About The Position

Responsible for the identification, appeal, resolution and reporting of all third-party payer claim denials at EvergreenHealth. Must have the ability to communicate and coordinate effectively with all levels of the institution and payer representatives. Responsible for analyzing denial activity to identify trends and denial sources and assists with the development of reports needed to investigate denial issues. Prepares, compiles, distributes and analyzes regular reports of denials and the financial impact.

Requirements

Associate's degree in related area or equivalent combination of education and experience
3 years of experience in a hospital or insurance industry setting
High degree of knowledge regarding health care services reimbursement methodologies
Knowledge of claim forms and remittance advices including coding and billing practices
Experience in healthcare billing and reimbursement
Ability to interpret contract language
Working knowledge of medical terminology

Nice To Haves

Bachelor's degree
Proficiency in Cerner and Meditech systems

Responsibilities

Identifies and captures claims denials from third-party payers in denial tracking software and/or alternative denial tracking tools on a daily basis and updates throughout the appeal process as activities and responses occur.
Responsible for the submission of written letters of appeal to third-party payers within allotted timeframes to prevent financial penalties.
Works with Case Management, Health Information Management and Patient Financial Services to gather supporting documentation to strengthen the appeals process.
Maintains contact with payers about disputed claims and updates system documentation of ongoing efforts for each claim.
Generates reports of denial activity including but not limited to analysis of trends, financial impact, success rate of appeals and root causes. Submits reports to the Director of Revenue Integrity on a monthly basis and as needed.
Monitors private payer resources and websites to identify changes in payer requirements and incorporates into denial management processes. Distributes relevant updates to other departments (e.g. Patient Access, PFS, etc.) as necessary.
Performs other duties as assigned.