Denials Appeal Rep TC

Ability to process and organize a large volume of record requests document scanning telephone calls electronic record documentation requirements.

Evaluates denied accounts sent to the Denials Management Department for review. Assigns denied accounts to appropriate department work queues for resolution. Identifies repetitive issues with the goal of identifying preventative solutions. Uses reports and work queues to identify accounts not worked in a timely manner and follows up with clinical and financial departments when this occurs.

Tracks the status and progress of appealed activity and payer appeal responses using work queues and well-organized records to assure established timelines are met.

Researches payer issues and recommends changes as appropriate. Review monthly payer updates that will be reported during the monthly Appeal/Denial meeting.

Maintain a strong collegial working relationship with payers to assure claims/appeals are processed appropriately.

Processes necessary Lifechart online adjustments or changes related to appeals as needed within the scope of job function.

Continually evaluates work-flow and identifies opportunities to improve process for full and complete payment for all hospital services rendered to patients to include the need for system updates after careful analysis.

Creates generates and maintains ad hoc reports as requested by Manager to assist in the daily operation of the department.

Participates in staff meetings councils quality improvement teams and other such meetings and committees as required.

Develops and maintains working relationship with Brown University Health affiliate departments as needed to ensure full data exchange.

Performs other duties as necessary.

WORK LOCATIONS/EXPECTIONS:

After orientation at the Corporate facilities work is performed based on the following options approved by management and with adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure.

� Full time schedule worked in office

� Full time schedule worked in a dedicated space in the home

� Part time schedule in office and in a dedicated space within the home

This is a hybrid role requiring a minimum of 2 days per in the office.

Schedules must be approved in advance by management who will allow for flexibility that does not interfere with the ability to accomplish all job functions within the said schedule. Staff are required to participate in scheduled meetings and be available to management throughout their scheduled hours. Staff must be signed into Microsoft Teams during their entire shift and communicate with Supervisor as directed.

Performs other duties as assigned.

High School Graduate or equivalent.

EXPERIENCE:

Experience and knowledge in hospital patient accounting or denials/appeals in similarly complex healthcare organization is preferred. Must be familiar with use of computers and Microsoft Office tools Ability to perform financial analysis preferred. Comprehensive knowledge of patient accounting activities in an automated networked multiple hospital environment preferred. Detailed knowledge of regulatory requirements preferred.

Demonstration of highly developed organizational ability communication skills and problem-solving skills.

SUPERVISORY RESPONSIBILITY:

None.