Denials Management Specialist

Penn Medicine • East Petersburg, PA • 6h ago

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Summary:

Maximizes cash collections and resolution of aged accounts through informed, consistent follow up activities. Responsible for the timely billing and follow-up of assigned accounts and for ensuring all accounts are paid correctly according to insurance contract terms. Consistently identifies account deficiencies that require subsequent follow-up and ensures all deficiencies are resolved. Escalates issues to supervisor and tracks data for trending and feedback purposes. Works within a structured team setting to ensure team goals and well as individual goals are met in an appropriate manner.

Responsibilities:

Analyzes and researches denials and follows-up with the appropriate payor, practice, and/or patient to resolve denial. Provides missing or additional information if necessary, to expedite the resolution of the denied claim.

Performs all appeals and denial recovery procedures needed to appropriately and accurately resolve denied claims.

Processes required adjustments to accounts, including charges credits, payment transfers, policy adjustments, etc. in a timely and accurate manner.

Maintains a thorough knowledge and understanding of all assigned payor contracts and requirements.

Performs research to ensure current policies, applicable coding and insurance guidelines, regulations and laws are being followed.

Evaluates processes and procedures and makes practical suggestions/recommendations for improvement or compliance.

Prepares accurate and timely reports of trends and problems as they are identified. Communicates such trends to management in a timely manner.

Consistently identifies account deficiencies that require follow up and ensures that appropriate actions have occurred.

Completes work accurately and timely with appropriate documentation.

Ensures that all activities related to denials management functions meet department requirements, maximize revenue collection, and achieve leading practice levels of performance.

Consistently meets productivity and quality standards established by management, recommending new approaches for enhancing performance and productivity when appropriate.

Keeps Supervisor/Manager informed of any problems or issues.

Provides timely billing and follow-up of assigned inventory for the purpose of expediting timely account resolution.

Updates patient accounts to reflect any changes made to relevant information.

Contacts payers, employers, customers, attorneys, etc. in an effort to expedite the payment of accounts.

Processes and follows special accounts for resolution.

Assists with any special projects as assigned.

Credentials:

Education or Equivalent Experience:

Associate of Arts or Science

H.S. Diploma/GED (Required)

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

REQNUMBER: 291073

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