Lead Denial Specialist

WVU Medicine-posted 1 day ago
$17 - $25/Yr
Full-time • Mid Level
101-250 employees
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Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. Receives physician and patient communications to schedule patients and manages the registration process. Responsible for accurate and timely interviewing of patients and/or relative in a courteous manner to obtain registration data based upon comprehensive data elements to complete the registration process. Communicates with physician offices concerning clinical information and schedules clinical services.

  • Assists supervisor with employee selections process, coordinates and facilitates training for new employees, provides input to supervisor in regards to performance evaluation/competencies, communicates potential issues to supervisor as it relates to employee performance and training, and assists staff with resolution of problems in a timely manner.
  • Oversees day to day operations of Centralized scheduling department.
  • Schedules employees according to needs of department. Handles call offs.
  • Schedules outpatient procedures via telephone with patients and offices in a courteous, professional manner.
  • Coordinates multiple procedure patients have to ensure they are scheduled on the same day or within an appropriate time frame.
  • Provides patients and offices with accurate instructions regarding the schedule procedure (i.e. NPO, arrival time, where to arrive, etc.)
  • Checks order documents of completeness. Validate orders against scheduled services. Inputs outside orders into EPIC.
  • Clearly documents activities and actions take on accounts, which includes but not limited to authorization, communication with patients, staff and other departments.
  • Maintains scheduling and registration accuracy threshold of 95% as identified in audit processing.
  • Performs prior authorization process by performing medical review and entering authorizations into system.
  • Works and assists with the billing department in researching and resolving rejected, incorrectly paid, and denied claims as requested.
  • Obtains demographic/billing/insurance information from patient/family/legal guardian and correctly enters into the scheduling and registration/billing systems for service and claim processing.
  • Verifies insurance, validates pre-cert/pre-auth information after completion of insurance verification and record results in system. Preforms other insurance related functions as required or necessary.
  • Completes Medicare Secondary Payer forms, where applicable. Completes medical necessity screening. Verify medical necessity for applicable payer service.
  • Cancels or reschedules patients in accordance with hospital workflows.
  • Exercises proper stewardship through the appropriate us of supplies, equipment, and time
  • Follows hospital, state, and federal guidelines for ensuring safe environment for workers, patients and public. Ensures compliance by staff to hospital, governmental and insurance regulations.
  • Actively participates in in-services, staff meeting, continuing education courses, hospital wide committees, and other meetings as needed or required. May be scheduled to work various shifts based on departmental and patient needs.
  • Participates in the processes to assess and improve the services provided and compliance with regulatory requirements. Reports results assessment and improvement processes to the appropriate administrative level.
  • High School diploma or equivalent.
  • Three (3) years’ experience in a physician/hospital scheduling and registration (including obtaining prior authorizations, admissions, and insurance verifications) or business office environment.
  • Strong communication skills.
  • Excellent customer service and telephone etiquette.
  • Use a computer keyboard, monitor, and mouse.
  • Knowledge in admissions, registration, and insurance verification.
  • Working knowledge of office equipment and computers.
  • Must demonstrate the ability to use tact and diplomacy in dealing with others.
  • Knowledge of healthcare insurance plans.
  • Knowledge of hospital clinical departments and service protocols.
  • Knowledge of hospital payment plan guideline.
  • Knowledge of healthcare coding practices. Understands and uses applicable CPT and ICD-9 codes.
  • Ability to multi task and perform duties well, while under pressure, while meeting deadlines.
  • Medical
  • Dental
  • Vision
  • Disability Coverage
  • Tuition Program
  • Retirement
  • Paid Time Off
  • Wellness Program
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