Denials Management Assistant

McLaren Health Care; Lansing (MI); On-site; USD 36,000 - 52,000; Full time

Job summary

McLaren Health Care is seeking a Denials Support Clerk to assist the Denials Team in coordinating CMS and third-party payer denials and appeals, while performing essential clerical functions to keep the department running smoothly. The role involves determining inpatient vs observation based on medical necessity, supporting billing processes, and tracking denial data.

Strong communication with A/R, HIM, and finance is expected.

Qualifications

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

Responsibilities

• Assist the denials team in determining inpatient vs. observation based on medical necessity.
• Maintain knowledge of hospital billing processes and assist with retrospective billing issues and denials.
• Support denial management activities and ensure data is tracked, evaluated, and reported.
• Communicate with A/R, denials, finance/billing, and HIM to gather information to appeal.
• Monitor effectiveness of denial management and provide feedback on payor denials.
• Attend meetings and prepare agendas and minutes.

Skills

Clerical experience

Medical terminology

Education

High school diploma

Associate degree in healthcare

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: 26004542


• Daily Work Times: 8am - 4:30pm


• Hours Per Pay Period: 80


• On Call: No


• Weekends: No