Denials Process Representative

$18.14 - $22.88 hourly
  • Capital Health
  • Lawrenceville, Lawrence Township, NJ, USA
  • Oct 28, 2021
Full Time Administration/Operations

Job Description

Join our growing Patient Accounts team at Capital Health! In this role, you'll analyze all patient accounts denied of correct payment by Managed Care Payors & work with proper departments to ensure payments and collections of money owed to Capital Health. 

ESSENTIAL FUNCTIONS

  • Instructs and assists co-workers to identify and organize data relating to incorrect payments or denials for reconciliation and appeals.
  • Frequently receives, provides, clarifies or exchanges information with Managers/Directors within department. Has frequent interaction with Case Management, Quality Resource Management, Patient Access, and Patient Accounts.
  • Coordinates and attends denial work sessions with other hospital departments directly involved with denials process.
  • Utilizes Denial Management software to monitor and review monthly trends prior to report distribution.
  • Downloads and manipulates excel spreadsheets from Denial Management software to be distributed to various CH departments in order to identify denial patterns, trends, and issues.
  • Analyzes data obtained from Denial Management software and shares information with Director and staff.
  • Identifies trends for improvement in order to increase percentage of first pass clean claim submission.
  • Responsible for providing weekly report of claims referred to outsource denial management vendor.
  • Requests reports in HBOC and Aergo to gather information for purpose of identifying payment problems and trends.

Qualifications

High School diploma or GED

1 year of relevant experience in a healthcare setting

Schedule

Full time, days

Employment Type (feed only)

Full Time, Permanent