Lead Denial Management Specialist

Altru Health System•Grand Forks, ND

2d•$19 - $28•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. The role assists with the development and implementation of an appeals process for claims recovery strategies that will reflect performance improvements and compliance. It also works with Payer Enrollment ensuring provider/location are enrolled correctly with the payers. Additionally, this position assists in the maintenance, enhancement, and problem-solving of the Epic patient accounting systems by reviewing denials and implementing edits in charge review or claim edits to prevent future denials. The specialist reviews and tracks monthly adjustment codes to provide input to department, leadership, and physicians, preventing unnecessary adjustments. They create reports and dashboards on denial trending and financial impact, assist the Manager/Supervisor in defining new requirements, suggesting solutions, and testing additional systems or enhancements, and identify delays, inefficiencies, and errors that hinder the claim process. This role provides information on denial data on a regular schedule and tracks denials by third party payers and PPO networks to determine discrepancies with AHS patient access and billing systems. Finally, the Lead Denial Management Specialist shares information with staff and departments involved to institute corrective actions, promotes the activities, initiatives, and goals of Altru Health System and the Finance Team, supports and enforces policies and procedures, and performs other duties as assigned or needed.

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.