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Denials Management Specialist

Company: Randolph Hospital Inc
Location: Asheboro
Posted on: June 9, 2021

Job Description:

Coordinates all administrative activities with regard to medical claim denial management.# Following payer guidelines, legislation and regulations, the Denials Management Specialist is responsible to track, trend and provide root cause analysis of denials received by all payer types. #Conduct analysis on denials and appeals and identifies trends that present process improvement and revenue protection opportunities. #The Specialist will work with appropriate clinical directors addressing root causes of denials and resolve.# Specialist will compile data on inappropriate high volume denials, work with payers as well as internal Managed Care Specialist to resolve. ##Assists department leadership with ad-hoc reports and special projects.# Oversees the denial management system administration. #Monitors state and federal regulatory agencies to maintain up-to-date knowledge on changing rules and regulations affecting NCH denial prevention and management practice.# Clinical knowledge and experience preferred; Associates Degree in Nursing preferable.# Minimum of three years adjudication, reimbursement, denial management, utilization review or equivalent in a healthcare environment required.# Knowledge of medical terminology, including ICD10 codes, CPT and HCPC coding required.# Knowledge of health care reimbursement models, Medicare, Medicaid and Managed Care federal, state and other regulatory agency rules # regulations required.# Strong organizational skills with a high level of accuracy and attention to detail. Ability to analyze business problems and opportunities, and to provide effective, practical solutions while focusing on continuous improvement and innovation.# Strong investigative, analytical, and critical thinking skills.# Ability to synthesize information and concisely communicate either verbally or in writing findings and recommendations. Strong presentation skills with the ability to feel comfortable in presenting/defending audit logic to client and key stakeholders.# Healthcare reimbursement regulation and compliance experience required.# A strong knowledge of third-party reimbursement procedures.# Experience using Microsoft Office Products required. #Must have excellent interpersonal, organizational, and communication skills.# Experience working with cross-functional departments to research and resolve issues using innovative solutions.

Keywords: Randolph Hospital Inc, High Point , Denials Management Specialist, Other , Asheboro, North Carolina

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