Denials Specialist

Hospital for Special Surgery•New York, NY

3d•$27 - $41

About The Position

Denials Specialist The Denials Specialist will have responsibility for the management, reporting, recovery, and prevention of clinical and technical denials received on Hospital services.

Requirements

Bachelor’s Degree Preferred
2-3 years business office experience in a healthcare environment
Expert level Excel experience
Strong working knowledge of Microsoft Office Suite
Ability to multi-task and switch easily between assignments
Excellent phone etiquette and internal/external customer services skills
Demonstrates knowledge of insurance regulations and policies, payment policies/guidelines and the ability to communicate and work with payers to get claims resolved and paid accurately
Demonstrates in-depth knowledge and experience in the following technology solutions: patient accounting, optical imaging and scanning, appropriate use of AI, patient systems and internet- based insurance websites
Exceptional interpersonal and influencing skills; success at cultivating strong relationships with internal stakeholders and creating partnerships throughout the organization.
Experience working with executive and medical leadership, especially physicians and their offices.
Resolves issues through innovative problem solving and solution development; capable of gaining commitment to project goals.
Stays current on healthcare industry trends and reform; can identify potential impacts and /or problems that may arise during conversion and translate them into remedial action plans.
Outstanding communication skills: succinct and easy to understand, a good listener, skilled at influencing a variety of people.
Capable of developing and implementing educational programs for a diverse audience.
Unquestionable personal integrity. Exudes credibility and professionalism. Very likeable. Quickly builds confidence in others.
Team player and understands their role in relationship to others.
A highly committed individual, with the necessary drive and stamina to successfully oversee the denials management process.
Experience in Healthcare and Revenue Cycle preferred.
Open to recent graduates with the ability to think critically, learn and adapt.
Ability to adjust to rapidly changing procedures and protocols.
Established knowledge of healthcare and health insurance and familiarity with medical terminology a bonus.
Effective written and oral communication skills.
Technically savvy in all Microsoft Office products, particularly Excel.
Ability to be a great teammate and displays an outgoing and positive attitude toward assignments and colleagues.
Ability to preform calculations: addition, subtraction, percentages, understand payer reimbursement expectations and solve for variances.

Nice To Haves

Payment variance or denials management experience preferred
Established knowledge of healthcare and health insurance and familiarity with medical terminology a bonus.

Responsibilities

Reviews claims in which a denial has been received from the payer
Identifies the root cause of the denial and addresses the denial issue with the appropriate department (i.e., Billing, CDM, Clinical Documentation, Coding, etc.)
Utilizes available resources to effectively research claims and complete steps to submit information necessary to process or appeal claims
Independently manages assigned work
Produces reports on denial inventory as requested
Communicates trends in the claim denial populations to the leadership team
Investigates and ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims
Completes and requests adjustments to a claim, as appropriate
Organizes work/ resources to accomplish objectives and meet deadlines
Demonstrates critical thinking
Demonstrates problem-solving skills related to denial analysis
Manages multiple responsibilities with ease and completes tasks as assigned
Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively to obtain necessary information to address denial management issues
Participates in all educational activities, and demonstrates personal responsibility for job performance
Assists in the development of training material
Uses supplies and equipment effectively and efficiently
Consistently demonstrates a positive and professional attitude at work
Meets quality and productivity requirements to ensure excellent service is provided to customers
Maintains compliance with established corporate and departmental policies and procedures
Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, customers, and co-workers
Maintain satisfactory attendance and punctuality record as set forth by HSS policies
Responsible for the other relevant work functions, as requested
Ensures compliance of managed care companies with negotiated contracts.
Resolves denials and payor issues.
Manages appeal creation and submission both manual and AI created.
Maintains Documentation & Manages Information.
Creates and maintains reports on open AR and Insurance Payor issues.
Maintains satisfactory attendance record.
Maintains punctuality.
Adjusts to changing situations and work assignments.