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Position Summary:

Responsible for providing assistance to the Denials Team in the coordination of CMS and Third-party payer denials/appeals, as well as, performing

clerical functions to ensure the efficient operation of the department.

Essential Functions and Responsibilities as Assigned:

1. Assists with the team to determine the appropriate hospital setting (inpatient vs. observation) based on medical necessity.

2. Maintains current knowledge of hospital billing processes and participates in the resolution of retrospective billing issues including appeals, PACER authorization, third party payer certification, and denied cases.

3. Assists in performs retrospective denial management-related activities and functions to ensure that appropriate data are tracked, evaluated, and reported.

4. Communicates with A/R, denials, finance/billing, and HIM to render appropriate information needed to appeal/secure reimbursement dollars.

5. Assists with monitoring the effectiveness/outcomes of denial management. Provides prompt feedback regarding payor denials to the team.

6. Attends meetings and prepares agendas and minutes.

Qualifications:

_Required_

* High school diploma

* Two years of clerical experience

* One-year experience in a heath care environment utilizing medical terminology or have completed a college level course in medical terminology

_Preferred:_

+ Associate degree in healthcare related field

+ Two years of case management or utilization review, billing, or coding experience

* Three years of recent experience doing third party payer certification

+ Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross or equivalent through the Military Training network (MTN)