• HIS Denials Specialist (Inpatient)

    Saratoga Hospital (Saratoga Springs, NY)


    Summary of Position: Under general supervision of the Manager, Health Information Services, the Denials Specialist performs activities to ensure appropriate financial reimbursement for HIS inpatient services from payers. This position provides a vital link between inpatient coding, clinical documentation improvement, Patient Access (PA) and Patient Financial Services (PFS). The Denials Specialist is responsible for tracking denied HIS inpatient accounts, working with HIS Coders, payers, Department Directors, Clinical Managers, Case Management, Patient Access, and PFS. Actively contributes to the morale and teamwork of the staff and facility always presenting a positive attitude and patient minded vision with patient satisfaction as the continuing goal.

    Primary Job Responsibilities:

    + Uses software such as AUDAPRO, TRISUS, 3M, and Meditech. Conducts trend analysis to identify patterns and variances in denied accounts

    + Researches denied accounts to determine appropriate appeal/response to the denial notification to resolve claim.

    + Tracks denied and overturned accounts, compiling routine and ad hoc reports.

    + Develops and coordinates educational and training programs regarding trends in coding denials

    + Initiates corrective action to ensure resolution of problem areas identified during internal or external auditing and provides feedback and focused educational programs on the results of auditing and monitoring activities to affected staff and physicians.

    + Demonstrates competency in the use of computer applications and all coding convention and abstracting software and hardware currently in use by the Health Information Services Department.

     

    Minimum Qualifications: RHIT, RHIA, CCS, CPC, etc and 3 years of experience with coding, abstracting, or billing experience. (or other equivalent credential and experience.). Associate’s Degree Required, Bachelor Degree preferred.

     

    Salary Range: $21.78 - $35.90 Pay Grade: I Compensation may vary based upon, but not limited to: overall experience and qualifications, shift, and location.