Denials Management Analyst/ Scheduler

JOB SUMMARY:

• Works collaboratively with physicians, staff and other health care professionals at all three acute care facilities to review, address and prevent denials - technical, medical necessity, and others.
• Collaborates with all revenue cycle team members on daily case issues as well as developing system-wide quality improvement/performance improvement initiatives. Identify denials trends and develop appropriate plans to reduce.
• Schedule patients for Hospital testing as needed-this position will schedule for vacations, backlog, call offs etc. On the average, scheduling function should only be approximately 8 hours per week

QUALIFICATIONS:

Required Education and Experience

• BS/BA in Health Related Field or Finance preferred.

Training, Required Licensure and Certifications

• Experience with hospital billing and collections processes, skills demonstrated in appealing and reducing denials
• Scheduling Experience a plus
• Independent thinking and decision-making ability in appealing and reducing denials
• Excellent written, verbal, and interpersonal skills; ability to work in a team environment as well as independently
• Strong analytical skills necessary to collect, analyze and interpret denials data, resolve complex problems
• Preferred: Medical record audit and program development experience and public speaking, working knowledge of Interqual/Milliman admission criteria

ESSENTIAL KEY JOB RESPONSIBILITES:

• Provide guidance and support for all denials prevention.
• Actively manage, maintain and communicate denial / appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Revenue Cycle management.
• Coordinates large dollar denials for follow-up.
• Work with PIC tool to identify and resolve payment variances
• Assist with the development and implementation of policies, procedures, standards and initiatives to reduce denials.
• Work with revenue cycle denials team to identify denials issues and processes to correct using the denial software tool.
• Schedules patients for Hospital testing as needed
• Actively participate in monthly revenue cycle denial meetings to help reduce overall denials.
• Reports any trending and process improvement initiatives to CFO and key stakeholders
• Collaborates in the ongoing re-design and re-engineering of Denial functions, to meet the changing needs and priorities of the organization.
• Other duties as assigned