Denial Resolution Specialist I

Finance & Revenue Cycle Worcester, Massachusetts


Description

Position at UMass Memorial Health

Everyone Is a Caregiver.

At UMass Memorial Health Care, Everyone is a Caregiver regardless of title. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health care system of Central and Western Massachusetts, and a place where we can help you build the career you deserve. We are more than 14,000 employees, working together as one health care system. And everyone, in their own unique way, plays an important part, everyday.

Requisition #: 213037

Title: Denial Resolution Specialist I

Location: UMass Memorial Medical Center

Grade: ADM5

Posting Date: March 19, 2021 

Shift: Days

Status: Non-Exempt

Union: SHARE

Hours: 40

Shift Length: 8

Position Summary:

Responsible for reviewing, analyzing and initiating appropriate action for denial resolution by communicating with payers, hospital departments and patients for data as assigned

Major Responsibilities:

  • Completes appropriate actions needed for an effective appeal including conducting authorization research, rebilling, and balance write off or transfer to next responsible party. Escalates issues as appropriate.
  • Corresponds with third party payers, hospital departments, and patients to obtain information required for denial resolution following payer timelines. Releases information following Federal, State and Hospital guidelines.
  • Uses assigned work queues and prioritization standards and guidelines to perform denial resolution follow up.
  • Uses reference material to troubleshoot payer issues and increase understanding of denial resolution techniques. Reference payer websites as needed.
  • Analyzes and researches the denial reasons for each assigned denial code.

Position Qualifications:

License/Certification/Education:

Required:

  • High School diploma

Experience/Skills:

Required:

  • Previous Revenue Cycle knowledge in one of the following areas including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party Reimbursement.
  • Ability to perform assigned tasks efficiently and in timely manner.
  • Ability to work collaboratively and effectively with people.
  • Exceptional communication and interpersonal skills.

Preferred:

  • One or more years of experience in health care billing functions.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Standards of Respect: