Denials Specialist
West Tennessee Healthcare
•Onsite
About The Position
Under the general direction of the Director of Medical Oncology and the Business Manager, the denials specialist is responsible for timely and accurate resolution of denied insurance claims. The denials specialist will research, appeal, and track all departmental denials. Responsibility also includes the implementation of processes to prevent future denials.
Requirements
- Current licensure as a Registered Nurse as approved by the Tennessee Board of Nursing for practice in the State of Tennessee
- Competency in reading medical records.
- Minimum of 2 years hospital experience as a RN is required.
- Must have strong knowledge of computer software applications in word processing, spreadsheets and presentations, including MS Word, Excel and PowerPoint
- Must have high level of interpersonal skills.
- Position continually requires demonstrated professionalism, tact and diplomacy
- Must be able to work and communicate effectively with all areas of hospital personnel including ancillary departments, Nursing, Billing, Medical Records and Physicians
Nice To Haves
- Prefer experience with utilization review process involved in working with health plans
Responsibilities
- Partners with Revenue Cycle team and Business Office team to support resolution of retrospective denials.
- Responsible for understanding each payer’s medical necessity criteria.
- Performs written and verbal appeals for denials.
- Collaborates with physicians, nursing, coding, billing and others in appeals process.
- Tracks and trends denials.
- Identifies frequent root causes of denials and develops corrective action plan with appropriate departments.
- Tracks denial recovery data and generates monthly/quarterly/annual reports to show financial impact.
- Educates staff and physicians regarding processes to proactively reduce the risk of denials.
- Insures successful orientation and continuous education and development of clinical and clerical staff regarding denials prevention.
- Serves as an educational resource to staff.
- Makes management of aware of any issues or changes with payers.
- Assists with chart audits as necessary.
- Performs other duties as assigned or required.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
