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Orientation: 6 hours of non-billable time
OT: 8 hour shifts - OT after 8 hours
Department Name - Denials Analytics
Responsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends and providing monthly reports.
Responds to audit requests (including RAC) from payors.
Maintains a Library of Payer reference material regarding requirement for pre authorization, medical necessity and documentation requirements.
Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for future denials.
Reports to - Manager, Denials Analytics
Qualifications
o Required: High School diploma or equivalent
o Preferred: Associate degree
o Preferred: Certified coder or currently enrolled in a coding program
• Experience
o Required: Minimum of two years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing. Prior hospital billing experience is a plus.
o Preferred: three to five years of Patient Accounting in a high volume environment.
Specific Skills, Knowledge, Abilities Required
Hospital-Wide Supporting Commitments
o Demonstrates a commitment to change and growth in approach toward daily work
o Mobilizes the resources and energies of the health system towards success
o Looks for new business opportunities and makes suggestions for expanding our services
o Words and actions reinforce Eisenhower as an indispensable health care resource and promotes the likelihood of recommending the health system
o Adheres to hospital and department safety and compliance policies and procedures
o Wears identification badge at all times ensuring it can be read
o Completes annual health, safety, compliance reviews and any department/hospital specific requirements within the expected timeframe
o Acts as a Steward for Safety and corrects and/or reports any unsafe conditions to extension 4759 or employeesafety@emc.org
o Understands the importance of immediately reporting on-the-job injuries online and to your supervisor
o Accepts responsibility for own work
o Monitors own work to ensure quality; participates in continuous quality improvement
o Maintains sound judgment and reasoning; analyzes problems or procedures & selects correct course of action
o Explains tests, procedures, and services with patients to ensure thorough understanding
o Engages in opportunities to learn and grow by participating in training and educational programs
o Acknowledges each person in a sensitive, friendly contact & offers assistance as needed
o Provides an ”ideal” level of service by taking immediate action in addressing customer requests, needs, and concerns
o Uses pleasant/appropriate tone and positive verbal/nonverbal/written communication at all times
o Answers telephone by identifying department and name; and asks “How may I help you?”
o Treats everyone with courtesy and respect, not making excuses nor blaming other employees or departments; works together to improve customer service
o Treats co-workers as teammates, accepts/supports team decisions and the roles of others
o Develops trust and credibility with peers, supervisors, and customers
o Helps others during slow periods
o Applies new knowledge to innovate and continuously improve direct patient care and other supportive systems and operations
o Provides helpful, courteous, timely, and accurate responses to all individual
o Maintains a professional image and a clean, orderly environment that portrays an overall image of excellence
o Demonstrates compassion when dealing with difficult situations & takes initiative to resolve
o Creates a positive environment by not engaging in inappropriate communication
o Demonstrates a can-do attitude and embraces the culture of performance excellence
o Actively promotes a supportive setting that embraces the physical, emotional, and spiritual aspects of health and healing by creating a quiet, calm, pleasant and cheerful environment
o Adheres to all rules & standards around productivity, timeliness, overtime, & meal/rest periods
o Balances individual/team responsibilities to produce more efficiently
o Pays close attention to detail to standardize work, and eliminate waste and rework
o Makes a concerted effort to conserve hospital resources, i.e. electricity, supplies, water, etc.
o Adheres to all hospital, division and department policies and procedures
Essential Responsibilities
1. Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations
2. Analyze denied, underpaid and unpaid claims. Appeal underpaid and denied claims within timely filing periods
3. Identify, track and report on denial trends
4. Maintain an appeals data base to identify and report outcomes and opportunities
5. Identify any billing and/or coding trends resulting in denials and report to the Coding manager
6. Identify any other trends resulting in denials and report to Manager.
7. Attend all available coding and appeals related seminars as available
Job Type: Contract
Pay: $23.00 - $24.00 per hour
Schedule:
Experience:
Work Location: In person
Contractor
$95k-128k (estimate)
05/31/2024
09/26/2024