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Denials representative

Beaumont Health

This is a Full-time position in Southfield, MI posted November 14, 2019.

Position Title: Denials Representative  GENERAL SUMMARY: The Denials Analyst will be responsible for reviewing, researching and taking the next step based on the type of denial and protocol for the denial type.

ESSENTIAL DUTIES: Understanding of the revenue cycle and the responsibility and goals of each area and how they impact the revenue cycle.

Review all accounts that have a payer denial based on the Denial Management Policy and Procedure and take appropriate action based on the type of denial.

Documents all necessary elements; reason for denial/audit, denial status, action taken in the electronic medical record per denial management policy.

Understanding of current payer contracts.

Apply corrections to patient demographics, charges, adjustments and payments or when needed forwards to the appropriate department for correction.

Identify and provide communication and education on trends identified.

Appeal denials based on the appeal criteria found within the Denial Management policy and within appropriate denial due date timeframes.

Work with facility departs when necessary for resolution or appeal of denials related to that department (i.e Lab, Patient Access, Case Management).

Prepare and distribute a monthly denial log by facility to include account number, payor type, reason for denial when requested.

Identifies and communicates monthly denial trends and provides education as necessary to avoid recurring denials for the same denial reason code.

Send identified medical records as part of the denial/audit process via variety of methods expedited mail, electronic portal, payor portal or expedited ground currier service.

Will document appeal/additional documentation was sent in the electronic medical record once completed.

Follows payor or contractor denial/audit rules and timelines as outlined.

Performs appropriate follow up with payors on status of appeals/audits.

Follows appropriate next steps when denial has been upheld and completes correct adjustment process after the first level of denial is upheld.

Maintains a professional image and provides excellent customer service.

Attends department meetings and education sessions.

Meets/exceeds productivity and performance expectations within required timeframes.

Practices and adheres to the “Code of Conduct” philosophy and Mission and Values statement.

Adheres to all Beaumont Health Policies and Procedures.

Performs other duties as assigned.

STANDARD QUALIFICATIONS 1) Education / Training: High School Diploma 2) Work Experience : a) Relative work experience in a health care based setting preferred.

b) Knowledge of Revenue cycle structure and process.

The department will provide education and training thru HFMA (Healthcare Financial Management Association).

As an employee of the revenue cycle department the expectation is to obtain CRCR (Certified Revenue Cycle Representative) certification within 1 year of joining the department.