Resolution Specialist - FT - Days - Hybrid within Florida - MSS

Memorial Healthcare System; Florida; Presencial; USD 45.000 - 65.000; Jornada completa

Descripción de la vacante

Memorial Healthcare System in Miramar, FL is seeking a Denial Management Specialist to detect issues in managed care denials and underpayments and to develop plans for resolution. You will assist with spreadsheets of managed care accounts, work with management to respond to plans for settlement, and analyze denials to identify trends and collect on open balances.

Regularly report trends and progress to management and oversee denial communications to overturn denials at time of service.

Formación

• High School Diploma or Equivalent is required.
• Minimum 3 years experience in hospital/physician business office, managed care collections or managed care claims environment.

Responsabilidades

• Assist with preparation of spreadsheets of managed care accounts to be reviewed for settlement.
• Analyze and reconcile spreadsheets of managed care denials and underpayments and identify trends.
• Track and report statistics related to denial management processes.
• Coordinate denial correspondence and efforts to overturn denials at time of service.

Descripción del empleo

Location:

Miramar, Florida

Summary

Responsible to detect issues and analyze account balances resulting from managed care denials and underpayments and to develop plans for resolution.

Responsibilities

Assist with preparation of spreadsheets of managed care accounts to be reviewed for settlement. Work with management to formulate responses back to plan as needed to finalize settlement. Analyzes and reconciles spreadsheets of managed care denials, underpayments and aged accounts taking appropriate action to identify trends and collect on open balances to ensure successful achievement of departmental goals. Regularly report trends and progress of resolution to management. Track, Compile and report statistics related to front end denial management processes. Management and oversight of denial correspondence received from managed care plans at time of service. Coordinates handling of denials to ensure appropriate action and review is being taken in an effort to get denial overturned at time of service.

Competencies

ACCOUNTABILITY, ACCURACY, CUSTOMER SERVICE, MANAGED CARE COMPLIANCE APPEALS AND TRENDING, MANAGING BUSINESS PRIORITIES, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR, WORKLOAD MANAGEMENT

Education And Certification Requirements

High School Diploma or Equivalent (Required)

Additional Job Information

Complexity of Work: Requires critical thinking and effective communication skills. Must be able to demonstrate ability to make independent decisions. Requires detailed knowledge of government and managed care insurance terminology and reimbursement methodologies. Must have knowledge of federal and state regulations and laws/statutes related to payment for medical services. Requires knowledge of proper billing and coding of hospital services. Must be able to formulate and write formal business communications. Intermediate knowledge of Microsoft Word and Excel. Required Work Experience: 3 or more years experience in a hospital/physician business office, managed care collections or managed care claims environment required.

Working Conditions And Physical Requirements

• Bending and Stooping = 0%
• Climbing = 0%
• Keyboard Entry = 80%
• Kneeling = 0%
• Lifting/Carrying Patients 35 Pounds or Greater = 0%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 0%
• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
• Lifting or Carrying > 75 lbs Non-Patient = 0%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 0%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
• Pushing or Pulling > 75 lbs Non-Patient = 0%
• Reaching = 0%
• Repetitive Movement Foot/Leg = 0%
• Repetitive Movement Hand/Arm = 80%
• Running = 0%
• Sitting = 80%
• Squatting = 0%
• Standing = 60%
• Walking = 60%
• Audible Speech = 80%
• Hearing Acuity = 80%
• Smelling Acuity = 0%
• Taste Discrimination = 0%
• Depth Perception = 0%
• Distinguish Color = 0%
• Seeing - Far = 0%
• Seeing - Near = 80%
• Bio hazardous Waste = 0%
• Biological Hazards - Respiratory = 0%
• Biological Hazards - Skin or Ingestion = 0%
• Blood and/or Bodily Fluids = 0%
• Communicable Diseases and/or Pathogens = 0%
• Asbestos = 0%
• Cytotoxic Chemicals = 0%
• Dust = 0%
• Gas/Vapors/Fumes = 0%
• Hazardous Chemicals = 0%
• Hazardous Medication = 0%
• Latex = 0%
• Computer Monitor = 80%
• Domestic Animals = 0%
• Extreme Heat/Cold = 0%
• Fire Risk = 0%
• Hazardous Noise = 0%
• Heating Devices = 0%
• Hypoxia = 0%
• Laser/High Intensity Lights = 0%
• Magnetic Fields = 0%
• Moving Mechanical Parts = 0%
• Needles/Sharp Objects = 0%
• Potential Electric Shock = 0%
• Potential for Physical Assault = 0%
• Radiation = 0%
• Sudden Decompression During Flights = 0%
• Unprotected Heights = 0%
• Wet or Slippery Surfaces = 0%

Shift

Primarily for office workers - not eligible for shift differential

Disclaimer

This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.

Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.

Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.

Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.

We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.

Employment is subject to post offer, pre-placement assessment, including drug testing.

If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email [e-mail]