Denial Management Specialist

Position Title: Denial Management Specialist

Department: Revenue Cycle

General Purpose of Job Posltlon: Under the direction of the billing Operations Manager, the Denial Management Specialist is responsible for monitoring denials, appeals, and resolutions from participating jnsurance carriers and working proactively to collect from insurance carriers.

MINiMUM QUALIFICATIONS AND STANDARDS

Education: High School graduate or equivalent required.

Experience: Must have at least 4 years in substance abuse Revenue cycle

CertificationsfLIcensure: CPC required

GENERAL REQUIREMENTS

Physical Requirements: The physical demands below are typical of those that must be met by the employee to successfully perform the essential functions of the position. Requires normal vision, hearing, and/or the ability to effectively communicate both orally and in writing. Reasonable accommodations may be available for individuals with disabilities upon employee written request.

Never 0%

Occasionally (1-30%)

Frequently (31-60%)

Continuously (61 — 10

Lifting / Carrying: 1-10 lbs

X

Lifting / Carrying: 11-25 lbs

X

Lifting I Carrying: 26-50 lbs

X

Lifting / Carrying: over 50 lbs

X

Pushing / Pulling.• • 20-50 lbs

X

Pushing Pulling: over 50 lbs

X

Climbing / Balancing

X

Standing / Sitting

X

Walking

X

Working Environment:

• Primarily performed in a well-illuminated, climate-controlled, indoor, smoke-free business office environment within the facilities of Phoenix Behavioral Healthcare

Will be required to travel to other facilities within the organization in order to attend meetings, training sessions, etc.

• Scheduling hours: Primarily Monday — Friday during normal business hours. 8:00 am- 5:30 pm Work demands may require alternative and/or additional working hours based upon departmental and organizational needs.

Reporting Structure: Reports to the position of Rrevenue Cycle Director. In his/her absence, reports to the position of Billing and Collections Manager.

Overview Of Job Responsibilities:

I .Researches and analyzes denial data and coordinate denial recoveiY responsibilities.

2.1dentifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials

3.Develop reporting tools that effectively measure and monitor processes throughout the denials management

4.Prioritizes activities to work overturns in a timely manner to alleviate untimely filings

5.Uses reports that categorize denials to assign tasks or personally work to overturn denials

6.1deritifies and pursues opportunities for improvements in denial performance

7.Assists with chart audits as necessary

8.Processes work lists to facilitate prompt intervention of insurance denials

9.Researches. responds, and documents insurer and patient correspondence/inquiry notes regarding coding coverage, and reimbursement on accounts

10.Researches rejections included in EOB's for resolution and files appropriately

1 1 .Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks

12.HeIps when needed with retrieving mail delivered to office and sorts appropriately.