Community Health Systems Denial and Appeal Specialist in Brentwood, Tennessee

Description:

The Denial and Appeal Specialist is responsible forresearching, disputing, and appealing both denied and partially paid claims, aswell as identifying trends or patterns with insurance carriers and communicateany findings to hospitals.

KEY JOB RESPONSIBILITIES:

  • Researches and analyzes denial data and coordinate denialrecovery responsibilities.

  • Identifies, analyzes, and researches frequent root causes ofdenials and develops corrective action plans for resolution of denials.

  • Contacts insurance company to appeal denials and collectinsurance no payments or under payments.

  • Contacts the hospital or SSC to notify them of reason ofinsurance denial and potential resolution of denial which could includetraining staff or changes in system settings.

  • Completes appropriate actions needed for an effective appealincluding conducting authorization research, rebilling, and balance write offor transfer to next responsible party. Escalates issues as appropriate.

  • Responsible for coordination, analysis, tracking, andreporting of all denials and underpayments for multi-hospital operation.

  • Participates in inter-departmental resolution strategies toreduce and eliminate future denials. Researches complex denials as assigned.

  • Maintain and notate all appropriate information anddocumentation regarding customer and account status on computer system andprovide same to others involved with collections of accounts.

  • Work in a goal-oriented environment to meet productionindicators.

SUPERVISION PROVIDED BY THIS POSITION TITLE:

No direct supervisory responsibilities

Qualifications

EDUCATION/TRAINING & EXPERIENCE:

Education - High School diploma OR equivalent

EXPERIENCE:

  • Prior healthcare revenue cycle or patient accountingexperience required

  • Must be familiar with all insurance payer types

  • In-depth understanding of medical billing and coding

  • Excellent communication, persuasion and problem-solvingskills

  • Ability to maintain confidentiality and sensitiveinformation

KNOWLEDGE/SKILLS/ABILITIES:

  • Analytical -Synthesizes complex or diverse information; Collects and researches data; Usesintuition and experience to complement data; Designs work flows and procedures.

  • Problem Solving - Identifies and resolves problems in atimely manner; Gathers and analyzes information skillfully; Developsalternative solutions; Works well in group problem solving situations; Usesreason even when dealing with emotional topics.

  • Oral Communication - Speaks clearly and persuasively inpositive or negative situations; listens and gets clarification; Responds wellto questions; Demonstrates group presentation skills; Participates in meetings.

  • Written Communication - Writes clearly and informatively;Edits work for spelling and grammar; Varies writing style to meet needs;Presents numerical data effectively; Able to read and interpret writteninformation.

  • Quality - Demonstrates accuracy and thoroughness; Looks forways to improve and promote quality; Applies feedback to improve performance;Monitors own work to ensure quality.

  • Character - Demonstrates unquestionable integrity in everyaspect of work and dealing with others; Consistently models desired behaviorsand values established by the company; Respects diversity of perspective indiscussions and demonstrates an inclusive style; Demonstrates concerns for jobsafety for self and others.

  • Organizational Support - Follows policies and procedures;Completes administrative tasks correctly and on time; supports organization'sgoals and values; Supports affirmative action and respects diversity.

  • Dependability - Follows instructions, responds to managementdirection; Takes responsibility for own actions; Keeps commitments; Commits tolong hours of work when necessary to reach goals; Completes tasks on time ornotifies appropriate person with an alternate plan.

  • Administrative Management - Continuously managesadministrative functions to ensure quality and timeliness, manages accurate andtimely activity and performance reports.

Job: Corporate Positions

Organization:

Location: TN-Brentwood

Requisition ID: 1821385