Insurance Denials Specialist

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Title: Insurance Denials Specialist Job Code: 800300

Department/Location: Pt Accounts FLSA Status: Non Exempt

Reports to: Manager, Pt Accounts

Position Summary

The Denials Specialist is responsible for providing various support within the Medical (Hospital Centralized Business) Billing

Department. This position involves collecting and managing accounts, following up with insurance companies, reconciling accounts,

filing corrected claims, appealing claims when appropriate, and following up on all denials to ensure reprocessing and payment in a

timely manner.

Essential Functions and Responsibilities Includes the Following:

1. Understands and adheres to the WPH Performance Standards, Policies and Behaviors.(Process rejections, denials and other

correspondence received from third party payers in accordance with WPH procedure.s and guidelines in an effort to resolve

non-payment issues and rebill "clean" claims for payment.

2. Document accounts worked in Davincian/Meditech.

3. Responsible for the submission of appeals to third party payers in recover additional revenue

4. Investigate payer rejections and denials.

5. Work all Denials that pertain to including but not limited to, Duplicate Claim, Timely Filing, EOB requests, Not Medically

necessary denials, COB denials.

6. Responsible for reviewing and trending of denial issues, identify root cause and bring accounts to final resolution.n

7. Communicate information and make recommendation to improve current processes to eliminate future denials occurrence.

8. Performs all other related duties as assigned.

Education & Experience Requirements

High School Graduate required. Clerical Experience.

Previous hospital billing/follow up/denials experience required.

Ability to use basic office equipment and knowledge of CTR computer terminals required.

Medical terminology helpful but not mandatory.

Core Competencies

Ability to cooperate with others.

Must be able to speak, write understand and communicate the English language.

Effectively communicate with internal and external customers.

Integrity to handle the confidential aspects of work.

Retains composure under stress

Physical/Mental Demands/Requirements & Work Environment

May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may

be exposed to are listed in the hospital's SDS (Safety Data Sheet) data base and may be accessed through the

hospital's Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the

hospital switchboard, saved on a disc.

"Must be able to remain in stationary position 50% of the time

"The person in this position needs to occasionally move about inside the office to access file cabinets, office

machinery, etc

"The person in this position frequently communicates with patients who have questions, must be able to exchange

accurate information in these situations

"Must be able to detect and greet patients arriving

Primary Population Served

Check appropriate box(s) below:

Neonatal (birth - 28 days) Patients with exceptional communication needs

Infant (29 days - less than 1 year) Patients with developmental delays

Pediatric (1 - 12 years) Patients at end of life

Adolescent (13 - 17 years) Patients under isolation precautions

Adult (18 - 64 years) Patients with cultural needs

Geriatric (> 65 years) All populations

Bariatric Patients with weight related comorbidities Non-patient care population

The responsibilities and tasks outlined in this are not exhaustive and may change as determined

by the needs of White Plains Hospital.

Salary Range:$39,923.72-$59,885.48 Location: White Plains Hospital · Patient Accounting Schedule: Full Time, Day, M-F 8-4p