What are the responsibilities and job description for the Denials Management Lead position at Westchester Medical Center Health Network?
The denial management lead is responsible for the identification, mitigation, and prevention of clinical denials. This staff member reviews all initial denials to determine next steps and conducts review &/or appeals as appropriate.
Responsibilities
5 years of experience of direct experience in Hospital Billing, Follow-Up, Collections or Denials Management preferred. Ability to work independently, identify and resolve denial problems. 5 years of experience of direct experience in Hospital Billing, Follow-Up, Collections or Denials Management preferred.
Education
Bachelor’s Degree, preferred. 6-10 years of experience in healthcare billing or follow-up is acceptable in lieu of education requirement.
Other
If applicable, the individual performing this job may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.
Responsibilities
- Reviewing medical necessity, responding to authorization concerns, and/or reconciling coverage-related issues.
- The denial management specialist also works to prevent future clinical denials by communicating with clinical and revenue cycle leadership about denial root causes, such as documentation gaps or insufficient charge capture, and helps develop and implement staff education and process changes.
- Responsible for managing the process of completing collection and accounts receivable activities for denials and for ensuring all hospital collection-related activities meets the General Patient Accounting and Revenue Integrity department's requirements.
5 years of experience of direct experience in Hospital Billing, Follow-Up, Collections or Denials Management preferred. Ability to work independently, identify and resolve denial problems. 5 years of experience of direct experience in Hospital Billing, Follow-Up, Collections or Denials Management preferred.
Education
Bachelor’s Degree, preferred. 6-10 years of experience in healthcare billing or follow-up is acceptable in lieu of education requirement.
Other
If applicable, the individual performing this job may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.