What are the responsibilities and job description for the Denial Management Specialist, Department of Patient Financial Services position at BronxCare Health System?
Overview
Conduct review of denied claims and audits of registration/insurance verification activities to improve denial rates and enhance revenue. In-service staff on Insurance identification/verification and reporting. When directed, audit duties are under the direction of Compliance Program.
Responsibilities
- Establish and maintain positive relationships with patients, visitors, and other employees. Interacts professionally, courteously, and appropriately with patients, visitors and other employees. Behaves in a manner consistent with maintaining and furthering a positive public perception of Bronxcare Health System and its employees.
- Contributes to and participates in the Performance/Quality Improvement activities of the assigned department. Contribution and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, consistent adherence to the specific rules and regulations of the Bronxcare Health System (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service.
- Works with Clinic Administration to increase revenue and improve cash flow by reducing payment denials and system bill holds. Bill Hold Tracker to be kept up to date (Pre & Post Billing).
- Develops with Clinic Operations corrective action plans to improve insurance identification and reporting.
- Coordinates with Patient Financial Services (PFS) and Information Services to improve systems communication, tracking and reporting i.e. denial, hold and activity reports.
- Maintains a Clinic Insurance Eligibility Hotline for financial eligibility questions.
- Works with clinics and PFS to improve communication and feedback to ensure timely, complete and accurate billing.
- Informs clinics of policy, system and operational changes regarding insurance, eligibility and reporting, i.e. Managed Care Payers, Medicare. Keeps front-end administrators up-to-date with payer changes or guidance.
- Maintains and reconciles daily therapy services.
- Assists clinics in account updating and information reporting.
- Performs in-service as needed for insurance identification and reporting. Coaching and performance reviews for various clinic locations.
- Identifies that provider credentialing information is consistent in each system along the billing continuum and reports discrepancies to management.
- Identifies and reports operational issues to management and recommends corrective action plan helping to drive revenue.
- Identifies the specific reason codes for 277 responses and distributes to the billing managers on a daily basis.
- Epremis productivity and edits are monitored and reported on a weekly basis to identify possible high impact spikes. Then implements procedure changes in workflow to improve productivity.
- Registration Reconciliation Reporting with various departments.
- Miscellaneous insurance report reviewed daily and identified claims for possible correction.
- Reviews daily interface rejection report in a timely manner.
- Authorization/Correspondence to be scanned into the DMS system.
Qualifications
- Five (5) years of Hospital/Healthcare patient accounts experience.
- High School or GED
- Bachelor’s
- Basic Computer knowledge
