Specialist-Denial I - HS Denial Mitigation Corporate

Summary

Reviews clinical information and supporting documentation for outpatient or Part B services to determine appeal action. Reports to the manager of the Denial Mitigation Department. Performs other duties as assigned.

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.
• Completes assigned goals.

Requirements, Preferences and Experience

Education

Minimum: Ability to type and/or key accurately and have strong organizational skills.

Experience

Preferred: 3 years clinical experience and at least or 3 years payer experience.

Minimum: 2-5 years clinical experience in a clinical care setting.

Licensure, Registration, Certification

Preferred: RHIT;LPN;RN

Special Skills

Minimum: Excellent communication skills. Advanced computer literacy skills with the ability to type and key accurately.

Training

Minimum: Requires critical thinking and judgement and must demostrates the ability to appropriately use standard criteria established by payers.

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: 12103 - Specialist-Denial I
Facility: BMHS-Regional Business Office Jackson
Department: HS Denial Mitigation Corporate
Category: Finance and Accounting
Type: Non Clinical
Work Type: Full Time
Work Schedule: Days
Location: US:MS:Jackson
Located in the Jackson, MS metro area