Lead Denial Management Specialist

Altru Health System • Grand Forks, ND

17h • Onsite

About The Position

The Lead Denial Management Specialist serves as a resource in daily operations and participates in the development and implementation of policies and procedures. This position provides information on denial data and tracks denials by third party payers and PPO networks.

Requirements

• A minimum of 2 years Related Experience
• Proficiency in reading, writing, and speaking English to ensure effective communication in the workplace and with patients, families, and team members.

Nice To Haves

• Associates - Business - OR - Associates - Related Field

Responsibilities

• Assists with development and implementation of an appeals process for claims recovery strategies that will reflect performance improvements and compliance.
• Works with Payer Enrollment ensuring provider/location are enrolled correctly with the payers.
• Assists in maintenance, enhancement and problem solving of the Epic patient accounting systems by going thru denials and getting edits in charge review or claim edits to prevent denials.
• Reviews and tracks monthly adjustment codes to provide input to department, leadership and physicians, preventing unnecessary adjustments.
• Creates reports and dashboards on denial trending and financial impact that can be utilized to reflect performance improvements and compliance.
• Assists the Manager/Supervisor in defining new requirements, suggesting solutions and testing additional systems or enhancements.
• Identifies delays, inefficiencies and errors which hinder the claim process.
• Provides information on denial data on a regular schedule.
• Tracks denials by third party payers and PPO networks to determine discrepancies with AHS patient access and billing systems.
• Shares information with staff and departments involved to institute corrective actions.
• Promotes the activities, initiatives and goals made by Altru Health System and the Finance Team.
• Supports and enforces the policies and procedures that guide the duties and tasks performed daily.
• Performs other duties as assigned or needed to meet the needs of the department/organization.

Benefits

• health plan
• 401(k) retirement plan
• dental plan
• vision plan
• life and disability insurance
• education assistance
• paid time off (PTO)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree