Blanchard Valley Health System · 9 hours ago
Denials Management Specialist - 40 hrs/wk, 1st shift
Findlay, OH
Full-time
Onsite
Entry, Mid Level
2+ years expBlanchard Valley Health System is seeking a Denials Management Specialist to review denial notifications for claims and ensure timely reimbursement. The role involves analyzing denials, coordinating with multiple departments, and identifying trends to prevent future denials.
Health CareHospitalNursing and Residential Care
Responsibilities
Handles the end-to-end denial and appeal process, including the receiving, analyzing, tracking, managing, and/or resolving appeal with third-party payers in a timely manner. This includes the initial denial and any subsequent denial that comes from an unsuccessful appeal
Carries out appropriate research and analysis to help with the appeals process and stay informed of best practices and policy changes
Conducts clear, concise, and professional correspondence with payers and other stakeholders in accordance with organizational processes and expectations
Promotes interdepartmental coordination for finding a solution and offers suggestions for improvements
Examines payer remittance advice and determines the cause of loss of reimbursement in line with payer criteria
Accurately reviews clinical documentation to submit with the appeal that supports the requirements for payment but does not exceed the information necessary for a successful appeal
Utilizes payer websites research denials, submits information electronically, and follow up on appeals to expedite the payment process
Posts adjustments to claim balances that fall below the low balance threshold as outlined in the Denials Write-Off Approval Policy
Relays accurate information to support the appropriate party for A/R reduction and patient satisfaction
Identifies trends in denials, works to determine the root cause and successful solutions, shares findings with other members of the team to promote systemness in addressing denials
Participates in daily huddles, idea board meetings, staff meetings, and meeting with external departments for managing daily improvements
Communicates in a professional manner with patients, representatives from third party payor organizations, provider relations, contract management, other internal customers, and co-workers, etc. in a manner to achieve revenue cycle department AR goals
Identifies opportunities for system and process improvement and submit to management
Ensures that services are provided in accordance with state and federal regulations, organization policy, and compliance requirements
Qualification
Required
Two (2)+ years in previous patient accounting or billing experience
High School graduate or GED equivalent
Understanding of CPT, ICD-10, and HCPCS coding concepts. A CPC or specialty coding certification is required within 12 months of date of hire
CPFSS certification within the first 6 months of hire
The ability to understand and interpret payer policies and navigate payer websites
The ability to use the information to effectively develop an appeal that will result in the denial being overturned and receipt of accurate reimbursement. Follows the requirements for different appeal levels and uses the appropriate forms and method of appeal submission
An understanding of payer reimbursement methodologies and guidelines such as OPPS, IPPS, NCCI edits, etc
Ability to navigate provider documentation, test results, medication administration records, provider orders, etc. to accurately support the appeal process
An understanding of the requirements for a clean claim, including field requirements, for both the professional (CMS-1500) and the facility (UB-1450) claim types
Understand the remittance advice, remark codes, reason codes, and other payment information as it relates claims which have a denial posted
Knowledge of revenue cycle workflows and systems used within the Revenue Cycle such as Cerner, Trisus, Forvis, Quadax, KaiNexus, 3M, Experian, etc
Ability to compile, analyze and effectively present data and complex information in an informative and meaningful way to a variety of audiences, including leadership
Ability to effectively present/educate departments within the Revenue Cycle
Ability to manage complex issues and manage multiple tasks/projects. Excellent organizational and time management skills; detail oriented and follow through. Self-directed
Strong problem-solving, research and analytical skills
Positive service-oriented interpersonal and communication (written and verbal) skills required. Ability to effectively present and interact with all levels of the organization, including senior leadership
Preferred
Denial Management experience
College degree in a health-related field
Payment posting experience
Company
Blanchard Valley Health System
Blanchard Valley Health System is a health system that offers a continuum of care as per the needs of the community with quality services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Myron Lewis Lewis
President & CEO
Recent News
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