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*Description*

Summary:

Works closely with the physical advisors, Clinical Denial Specialist nurses, Case managers, Case Management Operation Coordinators, and Insurance companies. Sends provider appeals to insurance companies including Medicare and Medicaid for entire network. Provides support in all the administrative and clerical duties to promote efficient and effective department operation.

Responsibilities:

List 12 to 15 major accountabilities in order of importance and the estimated percentage of time spent on each accountability.

1. Reviews new and appeal upheld cases in work queue and incoming fax queue.

2. Reviews denial letters through daily mail.

3. Identifies retro denials and documents appropriately.

4. Notifies new retro denials to nurses in a timely manner.

5. Creates a weekly assignment for director to review for appeals.

6. Communicates with insurance companies to schedule a peer-to-peer review and follow up on the outcomes.

7. Send the appeals with appropriate documents to the payors within the payors� timeframe.

8. Documents and updates the denials in the denial tracking tool timely and accurately.

9. Collects and analyzes the data as requested.

10. Interacts professionally with team members within the department, other departments, and insurance companies.

11. Demonstrates the ability to be flexible and organizes during stressful situations.

12. Fulfills all compliance responsibilities related to the position.

13. Maintain and Model Nuvance Health Values

14. Demonstrates regular, reliable, and predictable attendance

15. Performs other duties as required.

Other Information:

High School Diploma or equivalent required

Prior Insurance claims processing experience helpful

Working Conditions:

Manual: significant manual skills/motor coord & finger dexterity

Occupational: Little or no potential for occupational risk

Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Physical Environment: Some exposure to dirt, odors, noise, human waste, etc.

Company: Danbury Hospital

Org Unit: 152

Department: Care Coordination-DH

Exempt: No

Salary Range: $20.86 - $38.73 Hourly

We are an equal opportunity employer

Qualified applicants are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other classification protected under applicable Federal, State or Local law.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation or our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to ensure that you are considered for current or future opportunities.