A Brief Overview
The Senior Denial Specialist is responsible for the timely and accurate resolution of denied claims in accordance with current contracts, federal regulations, and SHC policies. The Senior Denial Specialist serves as a subject matter expert and has extensive experience in denial resolution and recovery. Responsibilities may include high dollar and complex denial review and resolution, complex appeals, and serves as a mentor for new employees. The Senior Denial Specialist position is an expert-level position with a proven track record in hospital and physician denial resolution, and has an extensive knowledge of reimbursement requirements of all types of healthcare payers. A Senior Denial Specialist will act as a key resource for management in problem-solving difficult issues, analyzing complex accounts, and assisting with training needs.

Locations
Stanford Health Care

What you will do

• Work a broad range of denied claims taking necessary actions to recover and resolve in accordance with contracts, federal regulations, and SHC policies
• Conduct root-cause analysis on denied claims to identify opportunities for mitigation and escalation.
• Monitor high dollar and complex denial work queues, follow up on denied or underpaid appealed claims, and track appeal deadlines
• Collaborate with appropriate leadership and stakeholders to escalate trends and issues related to internal processes or external payer behavior.
• Maintain accurate documentation in Epic and related systems; ensure compliance with privacy and regulatory requirements.
• Support special projects related to high dollar or complex denials as assigned by management.
• Provide cross-functional communication with Revenue Cycle teammates, payers, and patients as needed to resolve denial issues professionally.

Education Qualifications

• High School diploma or GED equivalent

Experience Qualifications

• Five (5) years of progressively responsible and directly related work experience in healthcare revenue cycle, with a minimum of three (3) years of direct experience in denial management.

Required Knowledge, Skills and Abilities

• Working knowledge of government and non-government payer requirements, reimbursement rules, laws, and regulations that govern billing/collection activities
• Working knowledge of Epic Hospital and/or Professional Billing; proficiency in Epic reporting preferred
• Working knowledge of medical terminology, CPT-4, ICD-9/ICD-10, HCPCS, and modifiers, and how these items drive reimbursement
• Analytical and problem-solving skills, with good judgment, attention to detail, and thorough follow-through
• Excellent verbal and written communication skills; ability to present complex data clearly to stakeholders

Licenses and Certifications

• CPC - Certified Professional Coder required Upon Hire or
• CRCR - Certified Revenue Cycle Representative required Upon Hire

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family's perspective:

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination

Base Pay Scale: Generally starting at $38.91 - $43.82 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.