Denials Management Assistant

McLaren Health Care; Lansing (MI); On-site; USD 40,000 - 56,000; Full time

Job summary

McLaren Health Care in Michigan is seeking a Denials Team Assistant to support the coordination of CMS and third-party payer denials and appeals, and to handle clerical tasks that keep the department running smoothly.

The role involves determining inpatient vs. observation based on medical necessity, tracking denial outcomes, communicating with A/R, denials, and finance teams, and attending meetings with agendas and minutes. High school diploma and 2 years of clerical experience required.

Qualifications

• High school diploma required.
• Two years of clerical experience required or equivalent.
• Experience in healthcare with medical terminology preferred.

Responsibilities

• Assists the Denials Team in coordinating CMS and third-party payer denials/appeals.
• Supports determination of inpatient vs. observation based on medical necessity.
• Maintains knowledge of hospital billing processes and assists with retrospective denial management activities.

Skills

Clerical experience

Medical terminology

Education

High school diploma

Job description

Position Summary

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
• Requisition ID: 26011393
• Daily Work Times: 8am - 4:30pm
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No