Denials Management Specialist (Full-Time 40 hours/week)
Lancaster General Medical Grp
61020 PBS-Account Resolution
Professional Billing Services Account Resolution
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.
ATTENTION/CONCENTRATION – The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others:
- The position requires the ability to attend to more than one aspect of a situation simultaneously. It is highly likely that multiple task demands are going to be required of the individual at the same time.
NEW LEARNING AND MEMORY – The following level of ability is essential for the jobholder to learn and retain material:
- Job demands are only moderately routine and predictable. Minor changes may occur which require the individual to be able to understand and carry out detailed but uninvolved instructions.
PROBLEM SOLVING, REASONING AND CREATIVE THINKING – The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought:
- The position deals with issues or problems that often require thoughtful reasoning before arriving at approaches or solutions. Some independent thought, planning or origination of options and solutions is necessary. The individual must have the ability to apply principles of reasoning and problem solving to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
APTITUDES: The following are essential requirements of the position in relation to job-worker situations. These items describe how a worker must adapt, adjust, conform or act:
Leadership, control and planning: Ability to accept responsibility for leadership, direction, control, planning, negotiating, organizing, directing, supervising, formulating practices, or making final decisions.
Repetitive work: Ability to continuously perform the same type of work for extended periods of time, according to set procedures, sequence or pace.
Performing under stressful conditions: Ability to perform under stress when confronted with emergency, critical, unusual, or dangerous situations, or in situations in which working speed and sustained attention are critical aspects of the job. Is subject to danger or risk, or to tension as a regular, consistent part of the job.
Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.
Communication: Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.
Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.
EQUIPMENT USAGE REQUIREMENTS
Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies
Software: Microsoft Office Products, EPIC
Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%
- Sit: Frequently
- Stand: Occasionally
- Walk: Frequently
- Bend: Occasionally
- Push: Rarely
- Pull: Occasionally
- Kneel/Squat: Occasionally
- Reach: Occasionally
- Twist: Rarely
- Balance: Rarely
- Climb: Occasionally
Lifting: Degree of physical exertion is:
Moderate, exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.
Sensory Abilities specifically required:
WORKING CONDITIONS: Exposure to hazardous conditions/ materials is negligible.
Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards. The percentages of time spent performing job duties are estimates, and should not be considered absolute. The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole. Incumbent must be able to perform all job functions safely.
Posted on 02/25/2020