|
Summary: The Denials Specialist reports to
the Manager of PFS Denials Management. Under general direction and within established Lifespan policies and
procedures maximizes reimbursement from contracted payers through analysis
tracking and trending of denials using available metric denial reports.
Responsible for actively supporting the execution of strategic initiatives
process re-design root cause analysis metric/report development and special
projects as it relates to denials management. Executes the appeal process by
receiving assessing documenting tracking analyzing responding to and
and/or resolving appeals with third-party payers. Responsibilities: mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">ESSENTIAL FUNCTIONS: mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Consistently applies the
corporate values of respect honesty and fairness and the constant pursuit of
excellence in improving the health status of the people of the region through
the provision of customer-friendly geographically accessible and high-value
services within the environment of a comprehensive integrated academic health
system. Is responsible for knowing and
acting in accordance with the principles of the Lifespan Corporate Compliance
Program and Code of Conduct. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Evaluates denied accounts sent to
the Denials Management Department for review. Assigns denied accounts to
appropriate department workques for resolution. Identifies repetitive issues
with the goal of identifying preventative solutions. Runs reports and/or uses
workques to identify accounts not worked in a timely manner and follows up with
departments when this occurs. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Reviews denial database report
when denials are posted to correctly categorize provider liable denials their
root cause and resolution. Performs end of month reviews of the denial
database to identify and report on trends new issues areas of opportunity
and any other issues/changes related to the denial report that may be
appropriate. Responds to departmental
concerns about data on their monthly denial reports. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Develops and maintains a strong
working relationship with hospital departments and referring physician offices
to collaborate in obtaining information needed for successful appeal/reversal
of a denial. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Maintains current knowledge of
state and federal regulations accreditation and compliance requirements
Lifespan policies as well as payer specific policies including LCDs and NCDs
and payer contracts with Lifespan to identify cause of denials. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Researches payer issues resulting
in payment delays denials underpayments and processing deficiencies and
recommends changes as appropriate. Reviews monthly payer updates prepare a
report of the monthly payer updates to present during the monthly Appeal/Denial
meeting. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Tracks the status of appeals by
maintaining well organized records to ensure established timelines are met. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Maintains a strong working
relationship with payers to assure claims/appeals are processed appropriately. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Processes necessary LifeChart
online adjustments or changes related to appeals as needed within the scope of
job function. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Continually evaluates work flow
and identifies opportunities to improve process for full and complete payment
for all hospital services rendered to patients. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Creates generates and maintains
ad hoc reports as requested by Manager to assist in the daily operation of the
department. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Participates in staff meetings
councils quality improvement teams and other such meetings and committees as
required. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Develops and maintains working
relationship with Lifespan affiliate departments as needed to ensure fully data
exchange. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Performs other duties as
necessary. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> WORK LOCATIONS/EXPECTIONS: mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">After orientation at the
Corporate facilities work is performed based on the following options approved
by management and with adherence to a signed telecommuting work agreement and
Patient Financial Services Remote Access Policy and Procedure.. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">* Full
time schedule worked in office mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">* Full
time schedule worked in a dedicated space in the home mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">* Part
time schedule in office and in a dedicated space within the home mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Schedules must be approved in
advance by management who will allow for flexibility that does not interfere
with the ability to accomplish all job functions within the said schedule. Staff are required to participate in
scheduled meetings and be available to management throughout their scheduled
hours. Staff must be signed into
Microsoft Teams during their entire shift and communicate with Supervisor as
directed. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> Other information: mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">BASIC KNOWLEDGE: mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Associate*s degree in accounting
business office practices computer science or other related area or equivalent
experience. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">EXPERIENCE: mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Three to five years* experience
in hospital patient accounting.
Experience should demonstrate thorough knowledge of claims
administration in similarly complex healthcare organization. Must be familiar with ICD-9/10 CPT-4 coding
UB04 and HCFA 1500 claims administration.
Ability to perform financial analysis.
Comprehensive knowledge of patient accounting activities in an
automated networked multiple hospital environment. Detailed knowledge of regulatory requirements mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">INDEPENDENT ACTION: mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Incumbent functions independently
within scope of department policies and practices; refers specific problems to
supervisor only when clarification of departmental policies and procedures may
be required. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">SUPERVISORY RESPONSIBILITIES: mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">None. mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Lifespan is a VEVRAA Federal Contractor. Location: Corporate Headquarters USA:RI:Providence Work Type: Full Time Shift: Shift 1 Union: Non-Union
Apply
| 
Lifespan
Sep 18, 2024