Denial Resolution Specialist

Job Number 69819
Posted 2/6/2020
Account Northern Light Health Home Office
Department Patient Financial Services
Location |ME| Northern Light Mercy Hospital-Westbrook Campus, ME 04092
Schedule Regular Full-time
Shift Day
Hours 8am-430pm
Job Details
Job Summary:
This position is responsible for resolving the denials by all applicable payers of the Northern Light Health 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 Northern Light Health 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 Northern Light Health'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.

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

Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.

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