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Provider Enrollment Denials Analyst in Fairlawn, OH, US at TeamHealth

Date Posted: 9/11/2019

Job Snapshot

Job Description

Join a team of dynamic, results oriented professionals!

Named among “The World’s Most Admired Companies" by Fortune Magazine
Named among "America's 100 Most Trustworthy Companies" by Forbes magazine
Named among “Great Places to Work" by Becker’s Hospital Review

  • Career Growth Opportunities
  • Convenience market on site
  • Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
  • 401K program (Discretionary matching funds available)
  • Employee Assistance Program
  • Referral Program
  • Dental plans & Vision plans
  • GENEROUS Personal time off
  • Eight Paid Holidays per year
  • Quarterly incentive plans
  • Business casual dress code
  • Free Parking
  • Free coffee daily
  • Employee of the month awards with monetary gift and parking space
  • Training Programs
  • Fitness Center with personal trainer on site
  • Awesome Facility with terrific amenities
  • Wellness programs
  • Flexible work schedule

JOB DESCRIPTION OVERVIEW:

The Provider Enrollment Analyst reports to the Provider Enrollment Supervisor. The Provider Enrollment Analyst will review, organize, and verify all denials, pertaining to provider’s enrollment. The Provider Enrollment analyst will communicate with division the necessary action to correct/resolve the provider denial for payment.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Monitor and review all payment denials as assigned in ETM (Enterprise Task Manager) and process report findings to the division via DMS (Denials Management System).
  • Utilize the telephone and various carrier websites as research tools to expedite resolution for issues.
  • Assembles and forwards documentation to appeal disputed claims.
  • Contacts carriers to inquire on claims that have been denied and appealed.
  • Assembles and forwards appropriate documentation to the Senior Analyst for provider related issues.
  • Review carrier manuals and websites and informs management of any new procedures implemented by the carrier that are impacting the Akron Billing Center claims.
  • Reports any consistent errors found during claims review that may affect claims from being processed correctly.
  • Consistently meet and maintain the QA (95% or better) and designated production standards.
  • Performs additional duties as directed by the Provider Enrollment Senior/Supervisor or the A/R Manager.

 

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • Thorough knowledge of revenue cycle
  • Thorough knowledge of healthcare reimbursement guidelines
  • Computer literate, intermediate knowledge of Excel
  • Able to work in a fast-paced environment
  • Good organizational and analytical skill
  • Ability to work independently
  • High school diploma or equivalent.
  • One to three years’ experience in physician medical billing with emphasis on research and claim denials
  • General knowledge of ICD and CPT coding.

SUPERVISORY RESPONSIBILITIES:

  • None

PHYSICAL / ENVIRONMENTAL DEMANDS:

  • High production volume, fast-paced working environment
  • Extensive computer use
  • Job is performed in a well-lighted, climate controlled modern office setting.
  • Prolonged sitting at a workstation using a computer.
  • Moderate phone use.
  • Moderate bending and standing.
  • Moderate stress level.
  • Occasional lifting and carrying of up to 25 pounds.

This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.

DISCLAIMER:

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.