Denial Representative (FT, Days)

Under the direction of the Seamless Access Work Queue and Denials Manager, the Seamless Access Denial Representative is responsible for maintaining assigned work queues and resolving, trending and escalating issues to their leader. Additionally, this role will be active in denials root cause analysis, denial prevention, resolution, and appeals management. Maintains a high level of knowledge in payer requirements and Work Queue resolutions.

• Meets all standards of the Patient Satisfaction Initiative Criteria to make Jefferson Health System the Health system of choice for Patients and Employees
• Resolves accounts in assigned Seamless Access Work Queues in Epic, identifies systemic issues, and errors and communicates trends to leadership, including providing potential plan of resolution
• Maintains daily productivity and documents accounts effectively to prevent and resolve denials
• Works with Seamless Access Work Queue and Denials team and the training team to identify process improvements based on work queue and denial trending
• Assist with training and mentoring of registration staff based on work queue and denial findings
• Reviews denials and takes steps for resolution, including researching, drafting, and submitting appeals to payers. Also responsible for appeal follow up and account documentation
• Providing customer service to internal customers in a manner that demonstrates an understanding of payer requirements and the registration process
• Participation in long term projects providing reasonable suggestions and ideas to reach a successful completion
• Serve as a resource to staff on issues of insurance guidelines and requirements
• Promotes a strong and productive team environment; is a role model, creates a team climate characterized by honest, trust and open communication
• Performs other duties as assigned

Competencies (Knowledge, Skills, and Abilities Required):

Extensive computer skills (Excel, Word, PowerPoint), Exceptional knowledge of medical terminology, insurance guidelines and requirements, denials and coding. Excellent verbal and written communication skills. Ability to create and maintain professional relationships with internal and external customers, prior experience utilizing EMR, EHR systems. Excellent customer service skills. Knowledge of data trending and analysis is preferred but not required.

Minimum Education and Experience Requirements:

Education: GED or High School Diploma Required, Bachelorrsquo;s degree preferred or additional 4 yearsrsquo; experience in lieu of degree AND Experience: 4+ years progressive work experience in various positions within healthcare in the Patient Access and/or Patient Accounting Departments required. Prior experience in work queue resolution and/or experience in root cause analysis and denial prevention and appeals preferred.

Covid Vaccination is a requirement for employment at Jefferson for employees working at Jeffersonrsquo;s clinical entities or at the University. If you are not currently vaccinated you will be required to receive the vaccination prior to hire date if you are offered employment, unless you request and receive an approved medical or religious exemption from Jefferson.

About Jefferson

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow#39;s professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educashy;tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.