Denial Resolution Specialist, Outpatient Behavioral Health - Harrington Southbridge Campus - 40 hours, Days

UMass Memorial Health•Southbridge, MA

8d•Onsite

About The Position

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 and with EPICS experience.

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.
Determines and executes the best approach for denial resolution utilizing all available resources.
Follows payers established procedures and timelines to submit appeals utilizing payers preferred method, i.e., electronically or via paper.
Documents all actions taken during the denial resolution process clearly including actions taken, next steps, payer processing timelines, etc.
Adjusts account balances using correct transaction code adhering to established departmental policies.
Follows established protocols to ensure all documents are retained appropriately
Meets established quality and productivity standards.
Facilitates and promotes the sharing of knowledge and content throughout departments.
Follows all established Hospital Billing Revenue Cycle Management departmental and compliance policies and procedures.
Participates in cross training of billing resources.
Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
Maintains and fosters an organized, clean, and safe work environment.
Contributes to the development and application of process improvements. Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.