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Senior Denials Resolution Analyst in Akron, OH at TeamHealth

Date Posted: 3/4/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Akron, OH
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    3/4/2019

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 Denials Resolution Senior is responsible for monitoring workflow trends and communicating to the Denials Resolution Supervisor and A/R Manager. The Denials Resolution Senior is a resource for their assigned team as well as the Denials Resolution Supervisor and A/R Manager. The Denials Resolution Senior is responsible for compiling and preparing reports utilizing Enterprise Task Manager and the Informatics Reporting System when needed. The department’s goal is to examine and take action to support the provider’s interest in working denials and appealing to the insurance carriers when necessary.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Review ATB Reports - researching and reporting on any problematic areas.
  • Review Rejection PIT (Point in Time) Report for Open and Pended invoices for problematic areas.
  • Establishes and implements workflow priorities for assigned team based on PIT report review.
  • Review Rejection Outcome Report to Verify Invoices are worked properly.
  • Review Provider Hold and DMS Provider hold Reports.
  • Assist assigned team as needed to reach Monthly Metrics and Goals.
  • For each assigned team member review work performed, prepare QA reports and   communicate to each team member.
  • Responsible for training new employees and monitoring new employee production and QA. Reporting any concerns to the Denials Resolution Supervisor/A/R Manager.
  • Provides departmental leadership through example by performing in a Denials Resolution lead capacity including but not limited to adhering to work schedules; continuing significantly above average productivity and quality of assigned work.
  • Review carrier manuals and websites and informs management of any new procedures implemented by the carrier that are impacting claims.
  • Process Non-Routine Write-off adjustments as needed.
  • Conducts weekly tem meeting. PIT reports reviewed with analyst. Communication of staff changes in procedures and policies as needed and provide in-service training.
  • Ensures appeals and corrected invoices are being processed within schedule and according to the individual insurance company plans policy.
  • Complete Unaccounted claim report weekly
  • Update Collections Spreadsheet Weekly.
  • Communicate with the Denials Resolution Supervisor and A/R Manager on the progress of projects and assignments and progress toward completion on a timely basis.
  • Assist with any special Denials Resolution projects as directed by the Denials Resolution Supervisor/A/R Manager.
  • Other duties as assigned by the Denials Resolution Supervisor/A/R Manager.

 

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • Thorough knowledge of physician billing policies and procedures
  • Computer literate, working knowledge of Excel
  • Able to work in a fast-paced environment
  • Good organizational and analytical skills.
  • Good oral and written communication skills
  • Ability to work independently
  • Ability to lead assigned team.
  • High school diploma or equivalent
  • Minimum 3 years’ previous medical billing experience required with emphasis on research and claim denials
  • General knowledge of ICD and CPT coding

SUPERVISORY RESPONSIBILITIES:

  • Provides departmental leadership through example by performing in a Denials Resolution lead capacity.
  • Assists Denials Resolution Supervisor to ensure that Analysts are performing assigned duties and adhering to billing center/departmental policies, procedures and Code of Conduct.

PHYSICAL / ENVIRONMENTAL DEMANDS:

Extensive computer use.

High production volume, fast-paced working environment

  • 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.