Specialist-Denial Escalation

Summary

This position is responsible for conducting financial and contractual analytic reviews of patient accounts with regard to financial responsibility of both patient and payer and contractual responsibility of payer as it relates to healthcare provided within BMHCC. The position will require thorough analysis and interpretation of payer contracts as well as state and federal regulatory guidelines in order to maximize revenue realization. Efforts previously described will result in increased net revenues by reducing bad debt from potential write-offs due to lack of patient collections and overturns on payer denials. Interactions will primarily be conducted with contractually assigned payer representatives as well as state and federal resources. These efforts will drive actions in securing revenue for the organization and reduce system wide adjustments.

Responsibilities
• Reviews, assesses, and evaluates all communications received in order to optimize reimbursement.
• Evaluates clinical information and supportive documentation prior to initial appeal action in order to optimize reimbursement and utilization of resources.
• Prepares response to appeal/request for information based on supporting clinical information in order to enhance reimbursement and maximize customer satisfaction.
• Compiles, analyzes, and distributes necessary clinical and financial information and presents reports to other healthcare providers in order to improve performances, and increase awareness of resources consumed related to reimbursement.
• Appeal denials for payer external review and state escalations

• Completes assigned goals.

Requirements, Preferences and Experience

Experience with patient collections, registration and/or scheduling.

Basic understanding of Revenue Cycle functions, flow, and operations strongly preferred.

Experience level will also be a factor in lieu of educational requirements.

Education/Experience/Certification/Licensure/Technical/Other

I.Education:High School Diploma required.RHIT or LPN preferred with 2 yrs college preferred.Computer literacy and medical terminology required.

II.Experience: 2-4 years' experience in dynamic healthcare (clinic, physician, or acute hospital setting) or payer environment performing activities such as patient collections, payment applications, denials, registration and/or scheduling required.Appeal writing and payer experience preferred.

III.Certification/Licensure:Certified Healthcare Access Associate (CHAA) a plus.

IV.Software/Hardware: Comfort with data entry using Revenue Cycle software, patient management systems, payer systems and Windows-based applications preferred; competent utilizing Microsoft Office (Excel, Word, Powerpoint) a plus.

Preferred Skills

• Knowledge of health insurance and reimbursement/billing required.
• Ability to comprehend payer responses in all forms of communication.
• Professional writing skills.
• Excellent customer service skills.
• Excellent communication skills (verbal and written).
• Analytical skills
• Basic knowledge of healthcare finance.
• Conflict resolution
• Promotes quality and demonstrates accuracy and thoroughness
• Competent utilizing Microsoft office, Excel, PowerPoint
• Familiarity and experience with Revenue cycle software, tools, and technologies.
• Medical Terminology and working knowledge of Coding knowledge required.
• Time management and flexibility to meet work schedule demands.
• Good judgment and problem-solving skills (escalation process).
• Ability to work independently and take initiative.
• Ability to work with a high degree of confidentiality.
• Ability to manage multiple tasks simultaneously and adjust to issues as needed in a dynamic work environment.
• Proven ability and/or expressed willingness to work as part of a team.
• Privacy, Safety and Security- the individual observes privacy, safety and security procedures and uses equipment and materials properly.

About Baptist Memorial Health Care

At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.

At Baptist, We Offer:

• Competitive salaries
• Paid vacation/time off
• Continuing education opportunities
• Generous retirement plan
• Health insurance, including dental and vision
• Sick leave
• Service awards
• Free parking
• Short-term disability
• Life insurance
• Health care and dependent care spending accounts
• Education assistance/continuing education
• Employee referral program

Job Summary:
Position: 16961 - Specialist-Denial Escalation
Facility: BMHCC Corporate Office
Department: HS Denial Mitigation Corporate
Category: Finance and Accounting
Type: Non Clinical
Work Type: Full Time
Work Schedule: Days
Location: US:TN:Memphis
Located in the Memphis metro area

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