Denial Process Representative - FT - Lawrenceville

Work Shift:

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Position Overview:

Denial Process Representative

JOB CODE:50346

SUMMARY (BASIC PURPOSE OF THE JOB)

Analyzes all patient accounts denied of correct payment by Managed Care Payors and works with proper departments to ensure payments and collections of money owed to Capital Health (CH).

MINIMUM REQUIREMENTS

Education: High school diploma or equivalent.

Experience: One year related experience.

Other Credentials:

Knowledge and Skills:

Special Training:

Mental, Behavioral and Emotional Abilities:

Usual Work Day:8 Hours

ESSENTIAL FUNCTIONS

• Instructs and assists co-workers to identify and organize data relating to incorrect payments or denials for reconciliation and appeals.
• Frequently receives, provides, clarifies or exchanges information with Managers/Directors within department. Has frequent interaction with Case Management, Quality Resource Management, Patient Access, and Patient Accounts.
• Coordinates and attends denial work sessions with other hospital departments directly involved with denials process.
• Utilizes Denial Management software to monitor and review monthly trends prior to report distribution.
• Downloads and manipulates excel spreadsheets from Denial Management software to be distributed to various CH departments in order to identify denial patterns, trends, and issues.
• Analyzes data obtained from Denial Management software and shares information with Director and staff.
• Identifies trends for improvement in order to increase percentage of first pass clean claim submission.
• Responsible for providing weekly report of claims referred to outsource denial management vendor.
• Requests reports in HBOC and Aergo to gather information for purpose of identifying payment problems and trends.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

Frequent physical demands include: Sitting

Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion

Continuous physical demands include:

Lifting Floor to Waist 20 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing

Anticipated Occupational Exposure Risks Include the following: N/A

Offers are contingent upon successful completion of our onboarding process and pre-employment physical. Capital Health will require all applicants (including contractors, travelers and consultants) to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.

"Company will never ask candidates for social security numbers or date of birth during application phase. If you are asked for this information online, you may be a target for identity theft."