Denial Resolution Specialist II

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 #: 213223

Title: Denial Resolution Specialist II

Department: Hospital Billing-Denials/PAS-Financial Clearance

Grade: ADM6

Posting Date: March 19, 2021

Status: Non-Exempt

Shift: Days

Union: SHARE

Hours: 40

Shift Length: 8

Location: UMass Memorial Medical Center

Position Summary:

Responsible for reviewing, analyzing and initiating appropriate action for complex denial resolution by communicating with payers, hospital departments and patients. 

Major Responsibilities:

  • Triages denial root cause and executes appropriate next steps.
  • Identifies trends and participates in interdepartmental resolution strategies to reduce and eliminate future denials. Researches complex denials as assigned.
  • Trains staff on payer websites, providing basic guidance and instruction on website navigation.
  • Uses assigned work queues and prioritization standards and guidelines to perform denial resolution follow up. Work queues assigned will be representative of UMMHC more complex payers.
  • Resolves accounts denials with high dollar balances (>$100,00) recognizing the potential complexity and the need for rapid resolution.

Position Qualifications:

License/Certification/Education:

Required:

  • A minimum of a High School diploma.

Experience/Skills:

Required:

  • Four or more years of experience in health care billing functions.
  • Previous health care billing experience.
  • Proven track record of successful performance and goal achievement.
  • Experience in denial resolution process.
  • Advanced knowledge of claim form content and claim submission requirements. Understands and can explain the purpose of revenue codes, condition codes, occurrence codes, modifiers and value codes.
  • Proactively proposes resolutions to issues
  • Ability to communicate verbally and clearly document all actions taken during resolution process.
  • Demonstrates ability to research denial issues. Can provide root cause of denial issue and identify next steps needed to resolve issue.
  • Ability to navigate in MassHealth claims processing application and/or the Medicare claims processing application.
  • Experience with high dollar- high complexity claim submissions, i.e. Long length of stay, coverage changes and lapse, coordination of benefit issues
  • Ability to work collaboratively and effectively with people.
  • Exceptional communication and interpersonal skills.

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: