Denials Specialist

Westchester Medical Center; Town of Mount Pleasant (NY); On-site; USD 65,000 - 90,000; Full time

Job summary

Westchester Medical Center Health Network is seeking a Denials Specialist to analyze and report on Denial Management functions across the network. The role will enable reporting to track denial write-offs to optimize net revenue recognition and ensure the integrity of the denial process.

The position requires collaboration with clinical departments, on-site staff, and Patient Access to reduce recurring denials, monitor write-off codes, and provide insights to improve billing performance.

Qualifications

• Minimum of two to three years of experience in revenue cycle, denials management or related patient financial services
• Bachelor’s degree in business, finance, or healthcare administration preferred; equivalent work experience may substitute degree requirement
• Demonstrated knowledge of healthcare management, collections management, Medicaid and Medicare
• Experience in establishing and managing claim denial activities, collection processes and methodology
• Strong organizational skills and the ability to multi-task in a fast-paced environment

Responsibilities

• Coordinates data collection, analysis, appeal, write-off and reporting activities affecting the denial process
• Communicates with clinical departments, on-site staff, and Patient Access and Mid-Cycle coordinators to reduce recurring denials
• Ensures activities meet department requirements, maximizes revenue collection, and maintains performance standards
• Works with Revenue Integrity Leaders for charge-related denials and monitors denial vendor relationships
• Monitors contract compliance and escalates to Managed Care staff as needed
• Provides denial trends to Billing Functional Leader for operational improvement
• Works with Local System Coding leaders to determine appropriate changes for DRGs, CPT, and ICD PX related denials
• Displays a client-focused service approach and quality orientation
• Under the direction of the Denial Manager, analyzes denial reports and formulates resolution strategies
• Collaborates with the Follow-up Manager to set AR management and cash collection goals
• Creates a department dashboard and ensures KPIs are met daily, weekly, and monthly
• Uses automated systems effectively to perform work assignments
• Performs related duties as assigned

Job description

Job Summary:

The Denials Specialist is responsible for providing analysis and reporting for all Denial Management functions at Westchester Medical Center Health Network. The role will be responsible for enabling reporting to track and monitor denial write-offs to optimize net revenue recognition and recovery, while maintaining the overall integrity of the denial process.

Responsibilities:

• Coordinates all data collection, analysis, appeal, write-off and reporting activities affecting the denial process
• Communicates with clinical departments, on-site staff, and Patient Access and Mid-Cycle coordinators to reduce or eliminate unnecessary recurring denials and establishes appropriate prevention measures
• Ensures that all activities related to Denials Management functions meet department requirements, maximizes revenue collection, and achieves leading practice levels of performance
• Works with Revenue Integrity Leaders for charge related denials
• Monitors denial write-offs to ensure staff is using the appropriate write-off codes
• Monitors any denial vendor relationships for compliance and performance, and suggests modifications to Revenue Cycle leadership as necessary
• Monitors contract compliance and escalates to Managed Care staff as needed
• Provides denial trends to Billing Functional Leader for operational improvement
• Works with Local System Coding leaders to determine appropriate changes for DRGs, CPT, and ICD PX related denials
• Displays commitment to treating both internal and external constituents as clients and customers, maintaining a flexible customer service approach and orientation that emphasizes service satisfaction and quality

• Works under the direction of the Denial Manager to analyze denial and underpayment reports, provide feedback on root causes of denials, and formulate denials resolution strategies
• Works with the Follow-up Manager to establish and monitor accounts receivable management and cash collection goals and targets
• Creates a department dashboard
• Works under the direction of the Denial Manager to ensure that key performance metrics are met on a daily, weekly and monthly basis

• Effectively uses automated systems to perform work assignments
• Performs related duties as assigned

Qualifications/Requirements:

Experience:

A minimum of two to three years of experience in revenue cycle, denials management or related patient financial services

Education:

Bachelor’s degree in business, finance, or healthcare administration preferred; equivalent work experience may substitute degree requirement

Licenses / Certifications:

Other:

Special Requirements:

• Demonstrated knowledge of healthcare management, collections management, Medicaid and Medicare.
• Experience in establishing and managing claim denial activities, collection processes and methodology.
• Significant knowledge of healthcare payer reimbursement and proficiency in working with patient accounting systems.
• Clear understanding of the impact Denials Management services has on Revenue Cycle operations and financial performance.
• Knowledge of computer applications and equipment related to work.
• Strong organizational skills, working effectively in a multi-task environment, prioritizing tasks properly, and completing tasks/projects in a timely manner.
• Demonstrated proficiency in written and verbal communication skills.
• Ability to relate cooperatively and constructively with co-workers, administration, other clinic departments, providers, community agencies, referral sources and other health team members.
• Ability to work in a fast paced environment and remain flexible under stressful situations.