Denials Patient Account Rep - Audit Services FT Days

Torrance Memorial; Torrance, Northern (CA, KY); Hybrid; USD 35,000 - 53,000; Full time

Job summary

Torrance Memorial is seeking a Denials Patient Account Representative under the Revenue Cycle umbrella to review denied claims and manage appeals with third-party payers. The role supports relationships with payers and internal departments, ensuring compliance with related state and federal regulations and helping maximize reimbursement accuracy.

The position requires strong knowledge of denial management processes, extensive tracking, reporting, and collaboration with IT and other departments

Qualifications

• Bachelor's degree in business, healthcare, or related field or Associate's degree with 3 years of patient financial services.

Responsibilities

• Executes the denial appeals process for third-party payers with timely handling of appeals.
• Tracks the status and progress of denials and appeals.
• Researches to assist with completing the appeals process and stays informed on best practices.
• Maintains data on types of denials and root causes; collaborates on improvements.

Skills

Denials management

Payer communications

Data analysis

Process improvement

Customer relations

Contract management

Appeals tracking

Cross-functional collaboration

Deadline prioritization

System testing

Education

Bachelor's degree in business/healthcare or related field or Associate's with 3 years in patient financial services

Tools

Contract management system

Billing/claims systems

Job description

Under general direction of the Director, Revenue Cycle and guidance from the Denials Management Senior Analyst, the Denials Patient Account Rep is responsible for reviewing denied claims and carrying out the appeals process. Works to maintain third-party relationships, including responding to inquiries, complaints, and other correspondence. Knowledgeable of state/federal laws that relate to contracts and to the appeals process. Assists the Denials Management Senior Analyst with reports and provides ongoing support and maintenance to the Revenue Cycle process to maximize case flow and reduce denied claims.

Core Competencies

• Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third-party payers in a timely manner.
• Tracks the status and progress of denials and appeals.
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms.
• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues.
• Utilizes the Hospital's contract management system to identify accounts paid less than the expected reimbursement.
• Prepares, maintains, assists with, and submits reports, as required.
• Works with internal departments and external organizations to resolve appeals.
• Prioritizes workload requests to meet agreed upon deadlines.
• Collaborates with team members to continually improve services and engages in process and quality improvement initiatives.
• Identifies improvement opportunities and contributes to the testing of system modifications; works with IT staff and department managers to ensure proper implementation.
• Identifies and resolves problem issues independently.
• Elevates issues as appropriate to Supervisor.
• Promotes positive customer relations.

Department Specific Competencies

• Answers the telephone courteously within three rings, identifying self and department, routes calls, ascertains needs and takes accurate messages as appropriate.
• Interprets patient insurance benefit information and explains the amount allowed and paid by the customers insurance plan and how the amount owed by the patient was determined.
• Maintains advanced knowledge of payer-specific billing, claims processing requirements, payer regulations and payer best practices.

Education

Bachelor's degree in business, healthcare, or related field or Associate's degree with 3 years of patient financial services.

Experience

2 years of experience in Healthcare billing, collections, payment processing or denials management.

Compensation Range

$25.64 - $38.82 / Hour