Denial Resolution Specialist I
About The Position
At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. Responsible for reviewing, analyzing and initiating appropriate action for denial resolution by communicating with payers, hospital departments and patients for data as assigned Responsible for reviewing, analyzing and initiating appropriate action for denial resolution by communicating with payers, hospital departments and patients for data as assigned.
Requirements
- High School diploma
- Previous Revenue Cycle knowledge in one of the following areas including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party Reimbursement.
- Ability to perform assigned tasks efficiently and in timely manner.
- Ability to work collaboratively and effectively with people.
- Exceptional communication and interpersonal skills.
Nice To Haves
- One or more years of experience in health care billing functions.
Responsibilities
- Completes appropriate actions needed for an effective appeal including conducting authorization research, rebilling, and balance write off or transfer to next responsible party. Escalates issues as appropriate.
- Corresponds with third party payers, hospital departments, and patients to obtain information required for denial resolution following payer timelines.
- Releases information following Federal, State and Hospital guidelines.
- Uses assigned work queues and prioritization standards and guidelines to perform denial resolution follow up.
- Uses reference material to troubleshoot payer issues and increase understanding of denial resolution techniques. Reference payer websites as needed.
- Analyzes and researches the denial reasons for each assigned denial code.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
