Denials Management Assistant

McLaren Health Care; Grand Blanc (MI); On-site; USD 42,000 - 62,000; Full time

Job summary

McLaren Health Care is seeking a Denials Clerk to support the Denials Team in coordinating CMS and third-party payer denials and appeals, and perform clerical functions to ensure efficient operation.

You will assist in determining inpatient vs observation based on medical necessity, maintain knowledge of billing processes, and help track and report denial data.

The role requires a high school diploma, clerical experience, and familiarity with medical terminology; BLS certification is preferred.

Qualifications

• High school diploma is required.
• One-year healthcare environment experience using medical terminology or relevant coursework.
• Two years of clerical experience.

Responsibilities

• Assist the Denials Team in CMS and third-party payer denials/appeals.
• Determine inpatient vs. observation based on medical necessity.
• Support resolution of retrospective billing issues and denied cases.
• Communicate with A/R, denials, finance/billing, and HIM to provide information for appeals.
• Attend meetings and prepare agendas/minutes.

Skills

Clerical experience

Medical terminology knowledge

Education

High school diploma

Associate degree in healthcare related field

Job description

The McLaren system includes 12 hospitals across the state, ambulatory surgery centers, imaging centers, a 730-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 242,000 Michigan lives, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network, and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer center. McLaren has 20,000 full-, part-time and contracted employees and more than 93,000 network providers throughout Michigan.

Responsible for providing assistance to the Denials Team in the coordination of CMS and Third-party payer denials/appeals, as well as, performing clerical functions to ensure the efficient operation of the department.

Essential Functions and Responsibilities as Assigned:

• Assists with the team to determine the appropriate hospital setting (inpatient vs. observation) based on medical necessity.
• Maintains current knowledge of hospital billing processes and participates in the resolution of retrospective billing issues including appeals, PACER authorization, third party payer certification, and denied cases.
• Assists in performs retrospective denial management-related activities and functions to ensure that appropriate data are tracked, evaluated, and reported.
• Communicates with A/R, denials, finance/billing, and HIM to render appropriate information needed to appeal/secure reimbursement dollars.
• Assists with monitoring the effectiveness/outcomes of denial management. Provides prompt feedback regarding payor denials to the team.
• Attends meetings and prepares agendas and minutes.

Qualifications:

Required

• High school diploma
• Two years of clerical experience
• One-year experience in a heath care environment utilizing medical terminology or have completed a college level course in medical terminology

Preferred

• Associate degree in healthcare related field
• Two years of case management or utilization review, billing, or coding experience

• Three years of recent experience doing third party payer certification

• Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross or equivalent through the Military Training network (MTN)

Additional Information

• Schedule: Full-time
• Daily Work Times: 8am - 4:30pm
• On Call: No

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employmentwithout regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status,national origin, disability, genetic information, height or weight, protected veteran or other classificationprotected by law.