Denials AnalysitGREAT PLAINS HEALTH HR
Home Health Services
- To inspire health and healing by putting patients first - Always.
The Denial specialist is responsible for the Revenue Cycle process after the point of successful submission of claims. This position works closely with the claims specialist, as well as the Director of HomeCare Services. This position should actively search for solutions to problems and continually bring ideas and recommendations to management. Provides support to other positions within the department and organization
- High school degree or equivalent required
- Sit constantly
- Stand/walk frequently
- Lift floor to waist height 30 pounds occasionally; waist to waist 25 pounds occasionally; waist to overhead 20 pounds occasionally. And carry 10 pounds up to 25 feet occasionally.
- Reach overhead frequently standing and turn reaching shoulder height while sitting frequently.
- Fine motor coordination within normal limits for age and gender.
- Constant computer use.
- Visual acuity within normal limits.
- Reconcile Remittance Advices – Ability to understand the components of remittance advices from various payers. A thorough understanding of the specific payment business rules for each type of insurance – Medicare, Medicaid, Workers compensation, Commercial insurance plans, etc.
- Post Payments – Works with Patient Financial Services to verify receipt of funds for each remittance advice. Posts payments accurately to patient accounts with great attention to detail.
- Follow up on Improper Payments or Denails Including Appeals – Analyze and examine the root causes of denials, underpayments, and delay in payment. Take ownership of the position and provide useful information to proactively minimize issues and negative trends.
- Manages Accounts Receivable Aging –Ensure that follow-up and resolution occurs on patient account balances, and provide customer service for patients, payers, and vendors. Monitor reports to verify and maintain accurate, current accounts receivable.
- Patient or Payer Concerns – Addresses customer concerns surrounding billing and insurance. Communicates with customers and third parties as necessary to obtain resolution to questions and concerns.
- Interpersonal Skills – Must demonstrate strong interpersonal and persuasive abilities in order to establish and maintain a positive relationship with team members, management, third party payers, government agencies, vendors, and physicians.
- Maintenance of Medical Record – Ability to document in the electronic record, in a clear and concise manner, the details of all interactions relative to a patient’s account. Makes updates to the record as needed, including scanning of various documentation.
- Month-end/Year-end/Statistics – Demonstrates knowledge and understanding of department operations and software application. Able to extract data necessary to submit statistical data to management, Accounting, and others as requested. Performs Month-End and Year-End processes as required by management.
- Fully cross-trained for the claims specialist and acts as backup for that role in the absence of that team member.
- Demonstrates knowledge and understanding of Home Health/Hospice software application and office equipment and provides support for these as necessary.