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Denial Resolution Specialist
Category: Health Care Industry
  • Your pay will be discussed at your interview

Job code: lhw-e0-89738889

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Eastern Maine Healthcare System

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  Job posted:   Thu May 17, 2018
  Distance to work:   ? miles
  1 Views, 0 Applications  
Denial Resolution Specialist
**Job Summary**
This position is responsible for resolving the denials by all applicable payers of the EMHS Patient Account Services in a Centralized Business Office environment. This position is responsible for resolving denials in accordance with regulatory and contractual obligations. This position requires a thorough understanding of the requirements of the Government and Non-Government payment policies & payer contracts. In addition, this position is held accountable to adhere to the policies, procedures, and applicable laws; including metrics related to productivity and quality. This position works closely with a team of Denial Resolution Specialists to analyze and take corrective action on payer denials to ensure an optimum revenue cycle workflow.
**Education and Experience**
? High school diploma or equivalent required; associate's degree preferred.
? At least one year of healthcare denials experience preferred.
**Required Minimum Knowledge, Skills and Abilities**
? Detailed knowledge of payer regulations, principles of accounting, reimbursement concepts and automated account receivable systems.
? Knowledge of medical terminology, Current Procedural Terminology (CPT), and International Classification of Disease (ICD) preferred.
? Must possess strong problem solving skills.
? Ensures all denial functions performed are compliant with applicable laws and regulations.
? Excellent professional communication skills; both oral and written.
? Ability to understand payer policies, contracts and all applicable billing rules and regulations to facilitate decision making.
? Proficient with Microsoft business applications.
? Experience with EMHS patient accounting software is preferred.
? Customer oriented.
? Demonstrated ability to work independently and collaboratively.
**Essential Functions**
? Actively participate in team huddles and meetings by way of sharing knowledge, requesting information, and recommending process improvements.
? Work closely by way of problem solving with peers and leaders to address payer denial and processing issues or changes that directly impact the accounts receivable.
? Resolve assigned accounts in a timely and accurate manner, which maximizes reimbursement in compliance with payer regulations and the department's policy and procedures.
? Take necessary AR adjustments in accordance with the department's adjustment policy.
? Meet or exceed the EMHS performance standards as it relates to quality and productivity.
? Reviews, analyzes, and initiates appropriate action for complex denial resolution.
? Reviews applicable payer policies to determine accuracy of denial.
? Resolve payment disputes with payers by following appeal protocols and processes.
? Request relevant information from appropriate revenue cycle and clinical departments as required by payer.
Advises management of payer processing issues which may require attention in a timely manner.
? Ensure all functions related to denials support the team goals and objectives as well as EMHS's financial performance objectives.
? Thoroughly understand the department's key performance indicators.
? Maintain the knowledge of payer policies; complete AAHAM or other healthcare related webinars.
? Attend internal education sessions to enhance or gain new skills.
? Demonstrate departmental desire to provide community benefits by way of charitable events or contribution outside the four walls of the department.
**Organizational Values**
Passion: We demonstrate a passion for caring for others and the pursuit of service excellence in all that we do.
Integrity: We commit to the highest standards of behavior and doing the correct thing for the right reasons.
Partnership: Working together in collaboration and teamwork is more powerful than working alone.
Accountability: We take a responsible and disciplined approach to achieving our priorities and responding to an ever changing environment.
Innovation: We are capable of extraordinary creativity and are willing to explore new ideas to achieve our healthcare mission.
Respect: We respect the dignity, worth and rights of others.
**Physical Demands**
? Sedentary: Exerting up to 10 lbs. occasionally, sitting most of the time, and only brief periods of standing and walking.
? Requires the ability to travel to member organizations as needed

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