Denials Management Assistant

About the Role

Responsible for providing assistance to the Denials Team in the coordination of CMS and Third-party payer denials/appeals, as well as performing clerical functions to ensure the efficient operation of the department.

Responsibilities

• Assists with the team to determine the appropriate hospital setting (inpatient vs. observation) based on medical necessity.
• Maintains current knowledge of hospital billing processes and participates in the resolution of retrospective billing issues including appeals, PACER authorization, third party payer certification, and denied cases.
• Assists in performing retrospective denial management-related activities and functions to ensure that appropriate data are tracked, evaluated, and reported.
• Communicates with A/R, denials, finance/billing, and HIM to render appropriate information needed to appeal/secure reimbursement dollars.
• Assists with monitoring the effectiveness/outcomes of denial management.
• Provides prompt feedback regarding payor denials to the team.
• Attends meetings and prepares agendas and minutes.

Qualifications

• Required:
  • High school diploma
  • Two years of clerical experience
  • One-year experience in a healthcare environment utilizing medical terminology or completion of a college-level course in medical terminology
• Preferred:
  • Associate degree in a healthcare-related field
  • Two years of case management or utilization review, billing, or coding experience
  • Three years of recent experience doing third-party payer certification
  • Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross, or equivalent through the Military Training Network (MTN)

Schedule

• Full-time
• Daily work times: 8:00 AM – 4:30 PM
• Hours per pay period: 80
• On-call: No
• Weekends: No