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. Clinical expertise and knowledge for preparation to defend revenue through the appeal and escalation process with payers and governmental agencies is required.
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. An additional responsibility includes heavy extraction of clinical or other data from the medical record used to prepare clinical timelines supporting medical necessity or technical arguments when submitting escalations to various avenues.Preparing team for and participation in State Fair hearings when applicable is also included.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
• Knowledge of health insurance and reimbursement/billing required.
• Clinical expertise in the preparation of clinical summaries to defend revenue in the appeal and escalation process.
• 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.
• Preparing team for and participating in State Fair hearings when applicable.
• Ability to prepare clinical timelines supporting medical necessity or technical arguments from the medical record to be used when submitting escalations to various avenues.
Requirements, Preferences and Experience About Baptist Memorial Health Care
- Privacy, Safety and Security- the individual observes privacy, safety and security procedures and uses equipment and materials properly.
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
Position: 17565 - Specialist-Denial Escalation RN
Facility: BMHCC Corporate Office
Department: HS Denial Mitigation Corporate
Category: Finance and Accounting
Type: Non Clinical
Work Type: Full Time
Work Schedule: Days
Located in the Memphis metro area