North Oaks Medical Center jobs

Status: Full Time

Shift: 8:00a-4:30p

Exempt: No

Summary:

JOBSUMMARY: Responsible for coordinating and monitoring denial and appeal processes in a collaborative environment with the Denials Manager; responsible for working assigned specialties; combines denial knowledge to assist in reducing financial impact; collaborating with key stakeholders and assist in developing appeal strategies to include reference material for staff and feedback for revenue cycle team.

Other information:

FACTORS RELATING TO THE JOB

A.Experience, Knowledge and Skill

1.Previous Experience Required:

3 years of experience with hospital or professional billing, coding, payer denials and/or 3 years of accounts receivable follow up experience preferred.

2.Education Required:

High School diploma or equivalent.

3.Skill:

Demonstrates the ability to think critically, work independently, and be self-motivated for the role.

4.Physical Effort Required:

Strength: Sedentary Push: Sedentary Pull: Sedentary

Carry: Sedentary Lift: Sedentary Sit: Frequently

Stand: Sedentary Walk: Sedentary

5.Manual or Physical Skill Required:

Must have good visual acuity to determine quality of work. Requires sufficient dexterity to operate a computer keyboard, telephone, copier, ten-key calculator and other office equipment; long hours of sitting and working on a computer; minimal telephone contact; occasional lifting of files and/or boxes; periodic walking between various departments.

B. WORK COMPLEXITIES:

1.COMPLEXITY AND DIFFICULTY OF WORK:

Ability to handle stress for meeting deadlines and dealing with patients, family members, physicians, etc. Ability to make monetary collections and financial arrangements. Must have ability to work precisely with figures and details. Maintain working relationships and a cooperative attitude.

2.SERIOUSNESS OF ERRORS:

Inaccuracy when dealing with people could adversely affect the image and reputation of North Oaks Health Systems. Inaccuracy could cause incorrect billing and delayed payments on accounts, adversely affecting the organizations’ cash flow as well as our customers.

C. WORKING CONDITIONS:

1.HAZARDS:

Minimal

2.ADVERSE WORKING CONDITIONS:

Some distraction from other office activity and stress due to high volume of patient requests and problems that must be solved in a 24-72 hour time period, as well as dealing with irate patients.

D. CONTACTS:

1.CONTACTS WITH PATIENTS, GENERAL PUBLIC, OR OTHER COMPANIES:

Constant personal contact with coworkers to resolve denials; frequent contact with doctors' offices.

2.CONTACTS WITH OTHER DEPARTMENTS:

Regular contact with: Utilization Review, Medical Outreach, Payroll Department, and Admitting to research and follow up on patient accounts; nursing units to request patient visits; clinical departments to obtain billing information; frequent contact with health Information Management to assure accurate billing; all other departments for billing/denial questions.

E. RESPONSIBILITIES:

1.RESPONSIBILITY FOR YOUR SAFETY AND THE SAFETY OF OTHERS:

Keep office equipment, personal items, etc. away from walking areas. Adhere to all safety guidelines and remain familiar with the policies and procedures as set forth.

2.RESPONSIBILITY FOR COMPANY FUNDS OR PROPERTY:

Responsible for incoming payments on patient accounts, reviewing and posting of adjustments to accounts.

3.RESPONSIBILITY FOR CONFIDENTIALITY:

Safeguard and preserve confidentiality at all times.

4.RESPONSIBILITY OF JOB PERFORMANCE WITHOUT SUPERVISION:

Under general supervision, works independently on routine work; Supervisor and/or Coordinator is available to give advice or instructions on new or routine tasks.

5.RESPONSIBILITY FOR THE SUPERVISION OF OTHERS:

None

6.WORK SCHEDULE:

Office hours are 8:00 a.m. - 4:30 p.m., Monday through Friday. However, when necessary, work hours will be scheduled according to department needs. Possible

flex hours and working remote per patient financial services policy.

Responsibilities:

DESCRIPTION OF DUTIES:

1. Communicates openly in a transparent and professional demeanor during all interactions with customers and co-workers while providing clear and concise communication of trending and findings to both front line team members and senior executives.

2. Communicates to Denial Manager, Director, Co Workers by telephone, in meetings, email, and other necessary forms of communication in a clear, effective, and timely manner while additionally providing proactive updates on initiatives that involve time and effort from peers and other employees.

3. Will help educate in areas as needed on payer denials, denial reason and trending, interpretation of payer manuals, medical policies, and local/national coverage determinations.

4. Performs data mining and reporting activities that identify net positive impactful opportunities in denials and adjustments for the individual facilities and the system.

5. Works assigned claim edit and follow up work queues and meets the assigned productivity standards daily as well as assigned patient account work queues and responds with resolutions within the expected time frame.

6. Analyzes data from various sources (medical records, claims data, payer medical policies, etc.), determines the causes for denials of payment and partners with management to implement strategies to prevent future denials.

7. Will work with the payer medical policies, case specific documentation that is needed and help with appeal letters if applicable with the help of our Managed Care Auditor.

8. Will help in reviewing claim edits and denials and/or inquiries referred from other departments and assists in identifying root causes.

9. Works with denials team to ensure claim edit/denial trending data is accurate and that all metrics are reported appropriately including specific current procedural terminology (CPT)/healthcare common procedure coding system (HCPCS), denial reasons and appeals. Monitors recovery of payments and trends to identify corrective measures needed to prevent future edits/denials.

10.Follows North Oaks Health System’s compliance programs and all federal and state regulatory

guidelines.

11.Perform other duties as assigned.