Medical Billing Professional Denial Specialist

Brown Medicine

17h • Onsite

About The Position

Under general supervision of the Follow-up Supervisor, performs all duties necessary to follow up on outstanding claims and correct all denied claims for a large physician multi-specialty practice. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate.

Requirements

• Equivalent to a high school graduate.
• Knowledge of 3rd party billing to include ICD, CPT, HCPCS and 1500 claim forms.
• Demonstrated skills in critical thinking, diplomacy and relationship-building.
• Highly developed communication skills, successfully demonstrated in effectively working with a wide variety of people in both individual and team settings.
• Demonstrated problem-solving and inductive reasoning skills which manifest themselves in creative solutions for operational inefficiencies.

Nice To Haves

• One to three years of relevant experience in professional billing preferred.
• Experience with Epic a plus.

Responsibilities

• Review all denied claims, correct them in the system and send corrected/appealed claims as written correspondence, fax or via electronic submission.
• Identify and analyze denials and enact corrective measures as needed to effectively communicate and resolve payer errors.
• Continually maintain knowledge of payer specific updates via payer’s listservs, provider updates, webinars, meetings and websites.
• Understand and maintain compliance with HIPAA guidelines when handling patient information.
• Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials.
• Report to supervisor identification of denial trends resulting in revenue delays.
• Answers telephone inquiries from 3rd party payers; refer all unusual requests to supervisor.
• Retrieve appropriate medical records documentation based on third party requests.
• Refer all accounts to supervisor for additional review if the account cannot be resolved according to normal procedures.
• Work with management to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department.
• Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures, and objectives of the system and affiliates.
• Perform other related duties as required.

Benefits

• As Rhode Island's largest health system and private employer, Brown University Health is the state's premier provider of health services and includes the only Level I Trauma Center for southeastern New England.
• Today, more than 20,000 people work at Brown University Health and bring their unique skills, experiences, and compassion to their jobs every day.
• Formed in 1994, Brown University Health is a not-for-profit health system based in Providence, RI comprising three teaching hospitals of The Warren Alpert Medical School of Brown University: Rhode Island Hospital and its Hasbro Children's; The Miriam Hospital; and Bradley Hospital, the nation’s first psychiatric hospital for children; Newport Hospital, Saint Anne's Hospital and Morton Hospital, community hospitals offering a broad range of health services; Gateway Healthcare, the state’s largest provider of community behavioral health care; and Brown Health Medical Group, the largest multi-specialty practice in Rhode Island.
• Brown University Health is an equal opportunity employer that values diversity of cultural background, race, gender, age, religion, identity, ability, and perspectives - we are actively committed to a diverse workforce that represents the patients and community that we serve.
• We are invested in creating a respectful, inclusive, and equitable environment that supports the holistic well-being of our employees and their families.
• Join us and help build a healthier future for our patients - and for yourself.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED