Denials Appeals Representative

SUMMARY: The Denial Appeal Representative reports to the Patient Financial Services Technical Appeals Supervisor. Under general direction and within established Brown University Health policies and procedures, performs all administrative/clerical support duties needed to maximize reimbursement from contracted payers. Executes the appeal process by receiving, assessing, documenting, tracking, analyzing, responding to, and and/or resolving appeals with third-party payers. Uses available resources to analyze, track, and trend denials throughout the workflow. Processes a thorough understanding of the denials and appeals process and the ability work denials and appeals as needed, within the scope of job function. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Provides administrative/clerical support to the denials appeals process which includes receiving, assessing, documenting, tracking, responding to, and /or resolving denials with third party payers in a timely fashion. 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 claimsppeals 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. MINIMUM QUALIFICATIONS: EDUCATION: High School Graduate or equivalent. EXPERIENCE: Experience and knowledge in hospital patient accounting or denialsppeals 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. color:red Demonstration of highly developed organizational ability, communication skills, and problem-solving skills. SUPERVISORY RESPONSIBILITY: None.

Pay Range:

$20.55-$33.93

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

BHCS 15 LaSalle Square - 15 LaSalle Square Providence, Rhode Island 02903

Work Type:

M-F 7:00 am -3:30 pm

Work Shift:

Day

Daily Hours: 

8 hours

Driving Required:

No