Job Summary: Reporting to Supervisor of Clinical Follow Up, denials specialist reviews clinical authorization denials and determines appropriate actions per payor to overturn the denial. Functions as a hospital liason with external third-party payors to review authorization denials. Works with precertification department and other physician offices on authorization denials and trends. Reports denial trends per payor to Supervisor and suggests appropriate actions. Performs follow up on all investigations, reconsiderations, retro authorizations and appeals sent by the Clinical Follow Up team.
Minimum Requirements: HS diploma or equivalent. 1 year of insurance and/or medical billing experience. Effectively communicate electronically and verbally. MS word and excel experience. Website navigation and research abilities. Ability to handle multiple tasks, deadlines, and request utilizing appropriate time management skills. Team collaboration to achieve best outcomes of denied claims.
Work requires professional demeanor using effective communication skills with internal and external contacts while maintaining patient and hospital confidentiality as per HIPPA and LVHHN policies. Capable of interacting effectively with insurance carriers including the ability to review LVHN Contracts individual insurance company requirements/rules/regulations and current billing practices and processes. Computer literate with data entry skills and willingness to learn present or future software products utilized by the Clinical Follow Up department.
Preferred Qualifications: Background/certification/associate's degree. EPIC system navigation. Precertification and or billing/follow up experience.
Licensure and Certifications: Basic computer skills;Ability to work independently;Good communication skill;and verbal communication skills;and willing to take on added responsibility as needed.;ability to focus on details and coordinate multiple projects simultaneously;ability to set priorities;Ability to consistently meet deadlines;and use basic medical terminology. Ability to communicate effectively in verbal and written form. Ability to utilize excellent customer service skills with patients;Basic knowledge of Microsoft Office;Ability to work with colleagues at all levels
Posting ID: 593237225Posted: 2021-01-27Job Title: Denial Specialist