The Denials Management Specialist is responsible for analyzing, resolving, monitoring and reporting denial metrics.
The Denials Management Specialist is responsible for creating and analyzing reports to identify opportunities to reduce/eliminate denials. The specialist will work collaboratively with the Revenue Cycle Department to present findings for escalation and resolution. This position will be responsible for the development and maintenance of denial analytics, driving continuous improvement of reporting functionality.
RESPONSIBILITIES: The specific responsibilities include, but are not limited to:
- Ensures accurate report creation for the purposes of trend identification, root cause analysis, and denial prevention
- Provides reporting and operational support for management initiatives to maximize recoverable A/R
- Monitors the impact of reimbursement discrepancies
- Communicates with Revenue Cycle management to resolve outstanding denied claims and works collaboratively to develop prevention strategies
- Assists department lead with meeting organization and reporting
- Extracts and compiles data from multiple sources effectively while maintaining data integrity
- Streamlines reporting to maximize efficiency
- Prepare and present leadership reports
- Design, implement, and maintain department reports and databases
- Prioritizes work/resources to accomplish objectives and meet deadlines
- Maintains compliance with federal, state, and local regulations and HIPAA
- Maintains the privacy and security of all confidential and protected health information; job duties warrant a “high” level of computer system access (all necessary areas) to patient information ONLY for those job functions as outlined in this job description; uses and discloses only that information which is necessary to perform the function of the job
- Participates in necessary educational activities, and demonstrates personal responsibility for job performance
- Willingness to participate and share expertise on projects, committees , and other activities, as deemed appropriate
- Meets or exceeds expectations for data quality, customer service, payment variance management turn-around and productivity
- Maintains satisfactory attendance record and punctuality record as set forth by HSS
- Consistently demonstrates a positive and professional attitude at work
- Maintains stable performance under pressure
- Responsible for other related duties, as assigned
EDUCATION AND CERTIFICATIONS:
- Bachelors required
- Epic Knowledge Preferred
EXPERIENCE AND COMPETENCIES
- Demonstrated experience with database management (Epic Clarity, SQL, Tableau)
- Demonstrates proficiency in Microsoft Office applications; expert level proficiency in Excel
- Exceptional communication skills: succinct and easy to understand, a good listener
- Strong interpersonal and influencing skills; success at cultivating strong relationships with internal stakeholders and creating partnerships throughout the organization.
- Experience working with executive and medical leadership, especially physicians and their offices.
- Well organized and disciplined; can work independently and lead large organizational initiatives and teams through proper engagement and involvement to achieve desired results.
- Innovative problem solver; capable of gaining commitment to project goals.
- Stays current on healthcare industry trends and reform; can identify potential impacts and/or problems that may arise during conversation and translate them into remedial action plans.
- Unquestionable personal integrity. Exudes credibility and professionalism. Very likeable. Quickly builds confidence in others. Team player and understands his/her role in relationship to others.
- A highly committed individual, with the necessary drive and stamina to successfully oversee the denials and management process.