Denials Specialist Job at Hospital for Special Surgery
Overview:
If this describes you then let’s talk!
HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.
Denials Specialist
The Denials Specialist will have responsibility for the management, reporting, recovery, and prevention of clinical and technical denials received on Hospital services.
Qualifications:
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If this describes you then let’s talk!
HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.
Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.
Denials Specialist
Denials Management
Full Time
The Denials Specialist will have responsibility for the management, reporting, recovery, and prevention of clinical and technical denials received on Hospital services.
The Denials Specialist will report to the Supervisor, Denials Management.
RESPONSIBILITIES: The specific responsibilities include, but are not limited to:
- Reviews claims in which a denial has been received from the payer
- Identifies the root cause of the denial and addresses the denial issue with the appropriate department (i.e., Billing, CDM, Clinical Documentation, Coding, etc.)
- Utilizes available resources to effectively research claims and complete steps to submit information necessary to process or appeal claims
- Communicates trends in the claim denial populations to the leadership team
- Investigates and ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims
- Completes and requests adjustments to a claim, as appropriate
- Organizes work/ resources to accomplish objectives and meet deadlines
- Demonstrates problem-solving skills related to denial analysis
- Manages multiple responsibilities with ease and completes tasks as assigned
- Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively to obtain necessary information to address denial management issues
- Participates in all educational activities, and demonstrates personal responsibility for job performance
- Assists in the development of training material
- Uses supplies and equipment effectively and efficiently
- Consistently demonstrates a positive and professional attitude at work
- Meets productivity requirements to ensure excellent service is provided to customers
- Maintains compliance with established corporate and departmental policies and procedures
- Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, customers, and co-workers
- Maintain satisfactory attendance and punctuality record as set forth by HSS policies
- Responsible for the other relevant work functions, as requested
EDUCATION AND CERTIFICATIONS:
- Bachelors’ Degree required
- Epic Certification preferred
EXPERIENCE AND COMPETENCIES:
General
- Revenue cycle knowledge/experince required
- Expert level Excel experience required
- Minimum of 2-3 years business office experience in a healthcare environment
- Strong working knowledge of Microsoft Office Suite required
- Ability to multi-task required
- Excellent phone etiquette and internal/external customer services skills required
- Payment variance or denials management experience is preferred
- Demonstrates knowledge of insurance regulations and policies, payment policies/guidelines and the ability to communicate and work with payers to get claims resolved and paid accurately
- Demonstrate in-depth knowledge and experience in the following technology solutions: patient accounting, optical imaging and scanning, patient systems and internet- based insurance websites
PERSONAL CHARACTERISTICS:
- Exceptional interpersonal and influencing skills; success at cultivating strong relationships with internal stakeholders and creating partnerships throughout the organization. Experience working with executive and medical leadership, especially physicians and their offices.
- Resolves issues through innovative problem solving and solution development; capable of gaining commitment to project goals.
- Stays current on healthcare industry trends and reform; can identify potential impacts and /or problems that may arise during conversion and translate them into remedial action plans.
- Outstanding communication skills: succinct and easy to understand, a good listener, skilled at influencing a variety of people. Capable of developing and implementing educational programs for a diverse audience.
- Unquestionable personal integrity. Exudes credibility and professionalism. Very likeable. Quickly builds confidence on others. Team player and understands his/her role in relationship to others.
- A highly committed individual, with the necessary drive and stamina to successfully oversee the denials management process.
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