Denials Management Specialist - Revenue Integrity - Days - FT

Memorial Hospital at Gulfport•Biloxi, MS

About The Position

The Denials Management Specialist is responsible for managing denials and identifying ongoing process improvements to reduce new denials, final write-off denials, and pre-bill denials. The specialist works with the Team Lead on process improvement opportunities and coordinates with hospital and professional services billing and follow-up teams, Health Information Management, Release of Information, and coding. The role requires effective communication with internal and external members of the healthcare team.

Requirements

An associate's degree, or a high school diploma or equivalent with the required experience.
With an associate's degree, two years of experience in a revenue cycle role, including billing and follow-up.
With a high school diploma or equivalent, four years of experience in a revenue cycle role, including billing and follow-up.
Experience in a denials management role.

Responsibilities

Resolve payment rejections and denials and validate denial reasons.
Coordinate internal and external resources to overturn rejections.
Initiate and manage appeals as appropriate to obtain maximum reimbursement.
Work with the team leader and team members on process improvement opportunities.
Evaluate denials to determine and track root causes and implement corrective actions.
Identify denial trends and provide information to the denial team to help prevent future avoidable denials.
Validate the accuracy of Provider and Carrier invoices according to policy.
Manage the resolution of exceptions and issues.
Prepare reports on audit results, process improvement recommendations, and systemic payment errors.
Assist in developing financial data collection and tracking tools to analyze data and prioritize denial trends.
Coordinate with hospital and professional services billing and follow-up teams, Health Information Management, Release of Information, and coding.
Maintain effective communication with internal and external members of the healthcare team.