Completing the research, follow-up, and resolution of denials and underpayments from third-party payors according to payor contracts and processing any adjustments as required. This representative reports to the Manager of Denials Management.
1. Analyze and research reason(s) for denials or underpayments on each account assigned.
2. Follow worklist prioritization of accounts as established by department policies and procedures when resolving accounts.
3. Contact third-party payors and patient when necessary to the denials recovery process.
4. Request relevant information from appropriate Revenue Cycle and clinical departments as required through the course of the denial recovery process.
5. Make necessary adjustments to patient demographic, insurance, and account balance information; process appeals, rebills, adjusted bills and other requested information in order to resolve denied claims; track progress until issue is resolved.
6. Use electronic systems to track correspondence, document follow-up/appeals activities, and to confirm receipt and determination of denials appeals.
7. Understand payor contracts, state/national guidelines, and contract management system as appropriate per account; educate team as necessary.
8. Daily focus on attaining productivity standards, recommending new approaches for enhancing performance and productivity when appropriate.
9. Strive for positive patient experience.
10. Adhere to Piedmont organizational policies and procedures for relevant location and job scope.
11. Complete and/or attend mandatory training and education sessions within approved organizational guidelines and timeframes.
12. Other miscellaneous duties as assigned.
KNOWLEDGE, SKILLS, ABILITIES:Clear understanding of the impact denials and underpayments have on Revenue Cycle operations and financial performance.
Excellent written, verbal communication and interpersonal skills.
Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment.
Dedication to treating both internal and external constituents as clients and customers, maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality.
A demonstrated ability to use PC based office productivity tools (e.g. Microsoft Outlook, Microsoft Excel) as necessary; general computer skills necessary to work effectively in an office environment.
MINIMUM EDUCATION REQUIRED:
High School graduate or GED equivalent.
MINIMUM EXPERIENCE REQUIRED:
At least two (2) years prior related healthcare Revenue Cycle experience, preferably within denials/underpayments.
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Three (3) years of prior related healthcare Revenue Cycle experience with a focus in denials/underpayments preferred. Prior experience using Epic preferred.