Lead EHPB Denial Mgmt Specialist
Oversees and leads the daily activities of the EvergreenHealth Professional Billing (EHPB) Denial Management Team. Provides initial training of new employees and retraining of current employees. A lead primarily performs the same work as others in the classification; in addition is directly accountable for monitoring and reviewing work assignments of other employees, checking work for accuracy, or giving advice and work instructions to other employees. Supports and assists the manager with development of Denial Management policies, procedures and standards. Responsible for the identification, appeal, resolution of payer claim denials at EvergreenHealth Professional Billing. Must have the ability to communicate and coordinate effectively with all levels of the institution and payer representatives.
1. Provides orientation/training for new staff and ongoing education and training for existing staff on all aspects of the Denial Management processes.
2. Monitors work of Denial Management staff.
3. Manages staff schedules, including vacation/sick authorization and coverage of staff on leave as appropriate under the direction of the Manager.
4. Develops and maintains current written policies, standards and procedural guidelines for designated team responsibilities.
5. Performs all job functions as described in the EHPB Denial Management Specialist job description.
License, Certification, Education or Experience:
REQUIRED for the position:
a. High School graduate or equivalent.
b. 2 years previous experience in Professional Billing.
c. Proficiency in Cerner and Ideal systems.
d. A good understanding of CPT, Modifiers, HCPC, ICD-9 codes and medical terminologies
e. Knowledge of claim forms and remittance advices including coding and billing practices
f. Knowledge and experience in working with health care insurers' and their reimbursement systems , especially Medicare, Medicaid, Workers Compensation, Motor Vehicle and contract payers.
g. Demonstrated problem solving ability.
h. Demonstrated effective communication and leadership skills.
DESIRED for the position:
i. College degree/Vocational training in billing or business
j. Certified Professional Coder Certification