The Denials Management Specialist is responsible for creating and analyzing reports to identify opportunities to reduce/eliminate denials. The specialist will work collaboratively with the Revenue Cycle Department to present findings for escalation and resolution. This position will be responsible for the development and maintenance of denial analytics, driving continuous improvement of reporting functionality.
RESPONSIBILITIES: Responsibilities include, but are not limited to:
- Design, implement, and maintain department reports and databases
- Provides reporting and operational support for management initiatives
- Builds reporting for the purposes of trend identification, root cause analysis, and denial prevention.
- Extracts and compiles data from multiple sources effectively while maintaining data integrity.
- Streamlines and automates reporting to maximize efficiency
- Ability to analyze, resolve, monitor, and report on metrics
- Prepare and present leadership reports
- Assists department lead with meeting organization and
- Prioritizes work/resources to accomplish objectives and meet deadlines
- Maintains compliance with federal, state, and local regulations and HIPAA
- Maintains the privacy and security of all confidential and protected health information; job duties warrant a “high” level of computer system access (all necessary areas) to patient information ONLY for those job functions as outlined in this job description; uses and discloses only that information which is necessary to perform the function of the job
- Participates in necessary educational activities, and demonstrates personal responsibility for job performance
- Willingness to participate and share expertise on projects, committees , and other activities, as deemed appropriate
- Meets or exceeds expectations for data quality, customer service, payment variance management turn-around and productivity
- Maintains satisfactory attendance record and punctuality record as set forth by HSS
- Consistently demonstrates a positive and professional attitude at work
- Maintains stable performance under pressure
- Responsible for other related duties, as assigned
EDUCATION AND CERTIFICATIONS:
- Bachelors DegreeRequired
- SQL Knowledge Required
- JAVA, VBA, C Sharp, Python Knowledge Preferred
- Epic Knowledge Preferred
EXPERIENCE AND COMPETENCIES
- Demonstrated experience with database management (Epic Clarity, SQL, Tableau)
- Demonstrated proficiency in Microsoft Office applications; expert level proficiency in Excel
- Demonstrated programming knowledge
- Familiarity with Resolute HB
- Exceptional communication skills: succinct and easy to understand, a good listener
- Strong 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.
- Well organized and disciplined; can work independently and lead large organizational initiatives and teams through proper engagement and involvement to achieve desired results.
- Innovative problem solver; 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 conversation and translate them into remedial action plans.
- Unquestionable personal integrity. Exudes credibility and professionalism. Very likeable. Quickly builds confidence in 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 and management process.