Job Description:
Job Title: Denial Management Specialist
Job Code: 900097
Department: Revenue Cycle Management
Reports to: Director of Revenue Cycle
FLSA Status:
The Denial Specialist is responsible for working denials to ensure appropriate payment for Carrollton Regional Medical Center claims. Completes denial follow up and no response research with insurance carriers and patients.
Maintains full awareness of compliance issues in relation to any insurance contracts, and other insurance regulatory issues.
Contact payers to research and follow up on denials. Request for a copy of the full denial letter if available.
Resolve denials from third party payers. This includes submitting requested lab results, corresponding with practitioners to obtain medical records and resubmitting claims as needed.
Review and analyze claim denials, providing root cause trending to Supervisor.
Ensure that appeals are sent to Third Party Payers in compliance with contracts and government regulations.
Contacts patients to gain additional information or obtain AORs whenever necessary.
Communicating trends and problems to Supervisor
Maintain and protect sensitive and private information by keeping patient records confidential in accordance with Practice, HIPAA, local, state, and federal laws and regulations.
The information contained in this job description is intended to describe the essential job functions required of those assigned to this job. It is not intended to be an exhaustive list of all responsibilities, duties, knowledge, skills, and abilities needed to perform the job. Please note that management retains the right to assign or reassign duties and responsibilities to this job at any time. The ability to competently perform all the essential duties of the position, with or without reasonable accommodation, demonstrated commitment to effective customer service delivery, integrity, and the ability to work productively as a member of a team or work group are basic requirements of all positions at Carrollton Regional Medical Center.
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Bachelor's degree preferred.
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CRCR certification required (or completed within one year from hire date)
Physical Requirements: Continuously stand/walk or lift/handle/carry material or equipment of moderate weight (20 to 50 lbs.). Examples: Nurses, LVNs, and physical therapists.
Environment: Located in an indoor area with frequent exposure to mild physical discomfort from dust, fumes, temperature, and noise. Examples: patient cares providers and laboratory technicians
Respiratory Category: Job tasks potentially include frequent or routine exposure to aerosolized particulate matter or infectious respiratory droplet nuclei and required fit testing and the use of respiratory protection is a condition of employment."
Hazard 1, 2, or 3: OSHA Bloodborne Pathogen Category 1: Tasks that involve exposure to blood, body fluids, tissues, and other potentially infectious materials.
Hazard 4: Tasks that involve, or may involve, exposure to OSHA regulated substances as stated in MSDS.
While performing the duties of the job, the teammate is regularly required to stand, walk, reach with hands and arms, twist, stoop and kneel. Regularly required to use hands and fingers to handle or feel, talk or hear. Specific vision abilities include close, peripheral, depth perception, and ability to adjust focus.
- In an eight (8) hour workday:
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Sit 0 1 2 3 4 5 6 7 8 hours
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Stand 0 1 2 3 4 5 6 7 8 hours
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Walk 0 1 2 3 4 5 6 7 8 hours
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Job requires:
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Exposure to change of temperature or humidity
X
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Exposure to dust, fumes, or gases
X
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Being near moving equipment
X
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Job requires teammate to lift/carry:
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Job requires teammate to push/pull:
Teammate is expected to participate in appropriate continuing education as may be requested and/or required by their immediate supervisor. In addition, employee is expected to accept personal responsibility for other educational activities to enhance job-related skills and abilities. Teammate must attend mandatory education programs.
Carrollton Regional Medical Center strives to comply with the Americans with Disabilities Act and provides reasonable accommodations to enable otherwise qualified individuals with disabilities to perform the essential functions of a position. Teammates requesting a reasonable accommodation should contact the Human Resources Department.
I have read and I understand my job description including all responsibilities and accountabilities. I accept the responsibility this position represents, and I am committed to the continued success of the team. I also understand it is my responsibility to frequently review CRMC’s Employee Handbook located on HRMS.
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Teammate’s Signature Date
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Teammate’s Printed Name