Denials Management Specialist
At Lancaster General Health, our culture is what sets us apart and creates a lasting impression of our health system in the community and in the hearts of our patients and their families. A role with us is more than just a job, we ask that you Live Your Legacy at LGH by finding your passion in your everyday role, committing to those you serve, and reaching for your personal best.
We are recognized as 1 of only 9 hospitals in the entire country with awards in Medicare.Gov, LEAPFROG and Healthgrades Americas 50 Best Hospitals. We have attained five year Magnet ® recognition status for the fifth time with the American Nurses’ Credentialing Center (ANCC) and we are the 2018 recipient of the Foster G. McGaw Prize in recognition of the commitment to community service.
PENN MEDICINE LANCASTER GENERAL HEALTH offers a comprehensive benefits package:
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program so that our employees can stay actively engaged and committed to living their legacy every day. Together, we will continue to make medical advances that help people live longer, healthier lives.
Join us and be part of a team that empowers you to do more than your job and encourages you to:
Live Your Passion. Live Your Best. Live Your Commitment. Live Your Legacy.
HOURS: Full Time (1.0 FTE; 40hrs/wk) Monday-Friday 8:00am-4:30pm.
POSITION SUMMARY: Maximizes cash collections and resolution of aged accounts through informed, consistent follow up activities. Responsible for the timely billing and follow-up of assigned accounts and for ensuring all accounts are paid correctly according to insurance contract terms. Consistently identifies account deficiencies that require subsequent follow-up and ensures all deficiencies are resolved. Escalates issues to supervisor and tracks data for trending and feedback purposes. Works within a structured team setting to ensure team goals and well as individual goals are met in an appropriate manner.
ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:
- Analyzes and researches denials and follows-up with the appropriate payor, practice, and/or patient to resolve denial. Provides missing or additional information if necessary, to expedite the resolution of the denied claim.
- Performs all appeals and denial recovery procedures needed to appropriately and accurately resolve denied claims.
- Processes required adjustments to accounts, including charges credits, payment transfers, policy adjustments, etc. in a timely and accurate manner.
- Maintains a thorough knowledge and understanding of all assigned payor contracts and requirements.
- Performs research to ensure current policies, applicable coding and insurance guidelines, regulations and laws are being followed.
- Evaluates processes and procedures and makes practical suggestions/recommendations for improvement or compliance.
- Prepares accurate and timely reports of trends and problems as they are identified. Communicates such trends to management in a timely manner.
- Consistently identifies account deficiencies that require follow up and ensures that appropriate actions have occurred.
- Completes work accurately and timely with appropriate documentation.
- Ensures that all activities related to denials management functions meet department requirements, maximize revenue collection, and achieve leading practice levels of performance.
- Consistently meets productivity and quality standards established by management, recommending new approaches for enhancing performance and productivity when appropriate.
- Keeps Supervisor/Manager informed of any problems or issues.
SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:
- Provides timely billing and follow-up of assigned inventory for the purpose of expediting timely account resolution.
- Updates patient accounts to reflect any changes made to relevant information.
- Contacts payers, employers, customers, attorneys, etc. in an effort to expedite the payment of accounts.
- Processes and follows special accounts for resolution.
- Assists with any special projects as assigned.
- Other duties assigned.
MINIMUM REQUIRED QUALIFICATIONS:
- High School diploma or equivalent.
- Associate’s degree
- Strong written and verbal communication skills.
- Microsoft Office experience.
- Strong organization skills.
- Ability to apply strong analytical qualities.
- One (1) to two (2) years of experience in hospital or physician billing/insurance follow up.
This position is located in Lititz, PA. #LI-MD1
Benefits of Joining Penn Medicine Lancaster General Health:
PENN MEDICINE LANCASTER GENERAL HEALTH combines a Nationally Ranked Hospital with great schools, safe neighborhoods, affordable housing, local community events and festivals as well as a wealth of cultural and recreational activities. The scenic Susquehanna River Valley provides opportunities for fishing, skiing, kayaking, hiking and mountain biking in addition to easy access to NJ shoreline or Delaware beaches. Urban life is easily accessible, with New York, Baltimore, Philadelphia and Washington D.C. a train ride away. Local universities, Fulton Theatre, the downtown shopping and dining district and local sports teams make Lancaster a great place to Live, Work and Play.
PENN MEDICINE LANCASTER GENERAL HEALTH is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.
Search Firm Representatives please read carefully: PENN MEDICINE LANCASTER GENERAL HEALTH is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at PENN MEDICINE LANCASTER GENERAL HEALTH via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no fee will be paid in the event the candidate is hired by PENN MEDICINE LANCASTER GENERAL HEALTH as a result of the referral or through other means.
Posted on 11/08/2021