License or Certification Requirements:

Responsibilities:

• Daily review of denials identified by 835 files, manually posted R/As, EOBs, or Payer Correspondence in the Patient Accounting and/or Scanning system.
• Denial prevention - Identify denial trends; provide documentation, data and reporting to Senior Management and offer suggestions for process improvement to areas involved.
• Develop, implement and evaluate existing policies and procedures related to denials management.
• Identify and communicate system issues related to denials stemming from billing, edits, rejections and follow up work queues with the Epic Coordinators and Revenue Cycle Manager.
• Submit help tickets and work with Epic Application Coordinators and/or Analytics to resolve issues, including testing and training as necessary.
• Insure that all Clinical denials are assigned to the appropriate workflow and are written timely by the Utilization Review Staff.
• Maintain attendance at Managed Care In-services, onsite meetings and conference calls with Insurance Provider Representatives.
• Other duties as assigned.
• Provide training to peers assisting with denial management.
• Provides input as well as assisting with quality assurance process initiatives for Riverside Medical Center's Revenue Cycle as related to the improvement of the root cause of the denial.
• Responsible for submitting all Outpatient appeals denied due for Technical reasons.
• Responsible to maintain the Denial Management system and workflow.
• Working with the Application Analyst, the Denials Analyst will thoroughly test and document system upgrades and software modifications related to the Denial Management system.
Timely follow up on all successfully submitted appeals, by use of work lists and queues, until a determination is made on the appeal.
Education:
Essential:

• HIGH SCHOOL DIPLOMA

Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.

Riverside Medical Center proves that truly progressive medicine is being delivered in Chicago's southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedications is respected, where superior performance is rewarded with competitive salaries and excellent benefits.

Other information:

Exposure/Sensory Requirements

Exposure to:
Chemicals: Refer to MSDS manual
Video Display Terminals: Average
Blood and Body Fluids: Diagnostic composite of patients, frequent contact with intravenous devices, and high potential for contact with contaminated body fluids (blood, vomitus, stool) and administration of blood does create a high risk. Use of needleless IV system, universal precautions and protective equipment minimize risk..
TB or Airborne Pathogens: Patient diagnostic presentations do pose high risk. Usage of protective wear and universal precautions minimize risk.

Sensory requirements (speech, vision, smell, hearing, touch):
Speech: Required to communicate with patient/families/staff/doctors, coworkers, ancillary personnel and other department heads. Ability to ask for help.
Vision: Required to perform necessary assessments of patient status, medication administration, CIS usage, and reading active orders and lab reports.
Smell: Helpful to note presence of incontinence, vomitus, blood; electrical/fire safety.
Hearing: Necessary to hear alarms, calls for help and to hear patient verbalizations. Necessary to hear lung, bowel and heart sounds. Needed to hear alarms (i.e., fire, codes via PA system).
Touch: Necessary to perform percussive assessments and to comfort patients. Also needed to manipulate tools and equipment.

Activity/Lifting Requirements

Average Hours per Week: 6-40

Shift: Variable for 24 hour coverage

Percentage of time during the normal workday the employee is required to:
Sit: 10%
Twist: 4%
Stand: 40%
Crawl: 0%
Walk: 25%
Kneel: 1%
Lift: 10%
Drive: 0%
Squat: 1%
Climb: 1%
Bend: 30%
Reach above shoulders: 3%

The weight required to be lifted each normal workday according to the continuum described below:
Up to 10 lbs: Frequently
Up to 20 lbs: Frequently
Up to 35 lbs: Frequently
Up to 60 lbs: Occasionally
Up to 75 lbs: Not Required
Up to 100 lbs: Not Required
Over 100 lbs: Not Required

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):
Lifting patients off their beds that are unable to move independently is done with assistive lifting equipment. Horizontal movement of patients to and from carts/beds who are unable to move independently is done with assistive lifting equipment. Lifting equipment - carry 25'-150' waist high (IV bags, patient trays, charts). Filled laundry bags are filled half full so as not to weigh over 35#. Carry fire extinguishers up/down 3-4 flights of stairs and several yards in emergency.

Maximum consecutive time (minutes) during the normal workday for each activity:
Sit: 30
Twist: 15
Stand: 60
Crawl: 0
Walk: 10
Kneel: 0
Lift: 5
Drive: 0
Squat: 2
Climb: 1
Bend: 15
Reach above shoulders: 2

Repetitive use of hands (Frequency indicated):
Simple grasp up to 10# Normal weight: <5#>
Pushing & pulling - 50-200#: Occasionally
Fine Manipulation: Typing in computer, omnicell, using pens to chart, drawing up meds in syringe and administration, starting IV's.

Leg Strength - up to 50#: Occasionally-(repetitive use of foot or feet in operating machine control: utilized in positioning beds during transport; x-ray, surgery or in an emergency situation from floor to floor, locking beds or cardiac chairs.)

Environmental Factors & Special Hazards

Environmental Factors (Time Spent) :
Inside hours: 12
Outside hours : 0

Temperature: Normal Range
Lighting: Average
Noise levels: Average
Humidity: Normal Range
Atmosphere: Odors

Special Hazards : Radiation, Chemical, Explosive - Chemical-drugs; Explosive-oxygen; Radiation-cesium implants and radioactive iodine therapy.
Protective Clothing Required: Gowns, gloves, goggles, masks, HEPA masks for TB.