Job Details
Primary Function
Responsible for triage, review, and resolution of denied patient insurance claims. Preventing, investigating, analyzing, and working closely with Physician Advisors, Attendings, and Revenue Cycle to manage inventory of denials across multiple programs and ensure daily monitoring of the denial inquiry through the denial process.
Responsibilities
- Triage and process denials, in real time, as notification is received from the Health Insurance Companies (Payor).
- Record and track denial information through multiple communication systems.
- Communicate with Physician Advisors and Attending physicians to advise of the Denial, options that are open to work toward resolution and outcome of said options.
- Move Denials along appropriate channels and track progress to completion.
- Facilitate additional communication between Hospital Doctors and the Payor's Medical Directors.
- Process Denial outcomes and record information through multiple systems, complete any additional paperwork necessary, based on outcome.
- Work closely with Revenue Cycle Department communicating and tracking 3rd party appeal statuses.
- Communicates and tracks all clinical denial notification, documentation, and completion with Care Management Leadership, PAs, Attending providers, and the Revenue Cycle Department.
- Communicates and tracks all Denial completion with the Revenue Cycle Department for appropriate billing.
- Communicates between Revenue Cycle and Care Management staffs regarding questions and clarification patient's appropriate Level of Care.
- Preserves and protects patient confidentiality at all times.
- Works to effectively train new staff in the Denial process.
Job Qualifications and Specifications High School Diploma with two to three years' experience in a healthcare setting. Insurance claims or medical billing experience preferred with a strong background in customer service. Working knowledge of medical terminology and strong written and oral communication skills are required. Must be able to adapt to continual process changes and exhibit strong organizational skills. Experience in computer applications including work processing, spreadsheet, and databases required.
Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.
Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.
EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status
Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.