Denial Prevention Specialist

Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, Fred Hutch is the only National Cancer Institute-designated cancer center in Washington.

With a track record of global leadership in bone marrow transplantation, HIV/AIDS prevention, immunotherapy and COVID-19 vaccines, Fred Hutch has earned a reputation as one of the world's leading cancer, infectious disease and biomedical research centers. Fred Hutch operates eight clinical care sites that provide medical oncology, infusion, radiation, proton therapy and related services, and network affiliations with hospitals in five states. Together, our fully integrated research and clinical care teams seek to discover new cures to the world's deadliest diseases and make life beyond cancer a reality.

At Fred Hutch we value collaboration, compassion, determination, excellence, innovation, integrity and respect. Our mission is directly tied to the humanity, dignity and inherent value of each employee, patient, community member and supporter. Our commitment to learning across our differences and similarities make us stronger. We seek employees who bring different and innovative ways of seeing the world and solving problems.

The Denial Prevention Specialist performs key activities related to clinical and administrative denial management. The individual is responsible for managing claim denials related to referral, authorizations, eligibility/registration, notifications, non-coverage, medical necessity, and others as assigned. The Denial Prevention Specialist conducts comprehensive reviews of the claim denial, account/guarantor notes associated with the denial, and the medical record to make determinations if a revised claim needs to be submitted, if a retro authorization needs to be obtained, if a written appeal is needed, or if no action is needed.

The Denial Prevention Specialist writes and submits professionally written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language. Appeals are submitted timely and tracked through final outcome. This incumbent will actively manage, maintain, and communicate denial / appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials to Denial Prevention Analyst. This role is key to securing reimbursement and minimizing organizational write-offs.

Research payer denials related to referral, pre-authorization, eligibility/registration, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
• Resolve denial records in Epic work queues to facilitate insurance liability is resolved.
• Independently write professional appeal letters.
• Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as Fred Hutch policies and procedures.
• Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
• Identify denial patterns and escalate to Denial Prevention Analyst as appropriate with sufficient information for additional follow-up, and/or root cause resolution.
• Make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials.
• Identify opportunities for process improvement and actively participate in process improvement initiatives.

Required:

• High School Diploma or equivalent.
• Minimum of one year of experience in a medical records related field.
• Critical thinking skills.
• Ability to work independently with minimal supervision.
• Medical terminology knowledge.
• Proficient in abstracting information from electronic medical records and other documentation.
• Ability to develop and maintain collaborative working relationships.
• Basic knowledge of health care business office practices and principles.
• Knowledge of Medicare, Medicaid and third-party reimbursement methodologies.
• Knowledge of local, state and federal health care regulations.

Preferred:

• Associate's or Bachelor's Degree.
• CCS, CPC, COC or CCS-P certification.
• Experience in the professional business writing, revenue cycle operations with working knowledge of coding principles and guidelines.
• Experience in hospital billing or facility coding.

The hourly pay range for this position is from $29.77 to $42.39 and pay offered will be based on experience and qualifications.

This position is not eligible for H-1B sponsorship at this time.

Fred Hutchinson Cancer Center offers employees a comprehensive benefits package designed to enhance health, well-being, and financial security. Benefits include medical/vision, dental, flexible spending accounts, life, disability, retirement, family life support, employee assistance program, onsite health clinic, tuition reimbursement, paid vacation (12-22 days per year), paid sick leave (12-25 days per year), paid holidays (13 days per year), paid parental leave (up to 4 weeks).