Resolution Specialist - FT - Days - MSS

Memorial Healthcare System; Florida; On-site; USD 55,000 - 75,000; Full time

Job summary

Memorial Healthcare System seeks a denial management specialist to detect issues and analyze account balances from managed care denials and underpayments. You will develop plans for resolution, track trends and report progress to management, and oversee denial correspondence to overturn denials at time of service.

You will work with management to prepare settlement-ready spreadsheets and craft responses to plans, ensuring accuracy and compliance in hospital billing practices.

Qualifications

• 3 or more years of experience in a hospital/physician business office, managed care collections or claims environment.
• Detailed knowledge of government and managed care insurance terminology and reimbursement methodologies.
• Familiarity with federal and state regulations and laws related to payment for medical services.
• Knowledge of proper billing and coding of hospital services.
• Ability to formulate and write formal business communications.

Responsibilities

• Analyzes and reconciles spreadsheets of managed care denials and underpayments to identify trends.
• Tracks, compiles and reports statistics related to denial management processes.
• Oversees denial correspondence from managed care plans at time of service.
• Coordinates handling of denials to ensure appropriate action and review.
• Assists with preparation of spreadsheets of managed care accounts for settlement reviews.
• Works with management to formulate responses to plans to finalize settlements.

Skills

Accountability

Accuracy

Customer Service

Managed Care

Problem Solving

Communication

Education

High School Diploma or Equivalent

Tools

Microsoft Word

Microsoft Excel

Job description

Location:Miramar, FloridaAt Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.Summary:Responsible to detect issues and analyze account balances resulting from managed care denials and underpayments and to develop plans for resolution.Responsibilities: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.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.Competencies:ACCOUNTABILITY, ACCURACY, CUSTOMER SERVICE, MANAGED CARE COMPLIANCE APPEALS AND TRENDING, MANAGING BUSINESS PRIORITIES, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR, WORKLOAD MANAGEMENTEducation 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 differentialDisclaimer: 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]