Organizes audit and denial related data into the Denial Computer Information System and assignment of audits to the appropriate team member to analyze and mitigate. Coordinates medical record and/or appeal submission, as requested, while following regulations and laws surrounding HIPPA. Follows workflow to ensure that the appropriate escalation, resubmission and completion of denials/appeals process is done on a timely basis. Generates reports within the Denials Computer information system to identify trends and issues related to denials and measuring KPI’s. Distributes the Important Medicare Message for Care Coordination.
- Under the direction of the Denials Manager provides data input, facilitation and compliance with dates for audits and denial correspondence as a member of the Revenue Cycle team.
- Records all required documents, tracks and follows up with payer to determine receipt of the appeal/documents and appeal determinations for all departments outside HIM.
- Assigns tasks to the appropriate party within the denials tracking system to ensure all steps in appeal process and data entry are completed by the right person.
- Develops and maintains necessary department and executive level reporting from the Denial Management Tool.
- Produces Key Performance Indicator (KPI) reports as requested.
- Identifies the root cause of the denial and addresses the denial issue with the appropriate department (i.e. Billing, CDM, Clinical Documentation, Coding, etc.)
- Organizes the work flow in the Denial Management tool to ensure that denials are worked according to timely filing deadlines and conditions of payment.
- Reviews, works and reports all claims that have aged more than the specified grace period stipulated in policies and / or contacts.
- Uses problem-solving skills related to denial analysis
- Works collaboratively with other key internal and external staff, both clinically and administratively, to obtain necessary information to address denial management issues.
- Identifies all denial trends and provides education of steps to prevent future avoidable denials.
- Assists in the facilitation and communication with the insurance carriers to obtain the case determination and communicates determination results via the Care Coordination system to each of the Care Coordinators.
- Communicates insurance determinations via the denials tracking system to applicable parties.
- Works collaboratively with Denial Manager on reporting trends and root causes.
- Performs other responsibilities within the Revenue Cycle departments as requested.
High School Diploma Or Equivalent Required
2 Years’ Experience in a Healthcare Environment Required
Required Knowledge and Skills:
Understanding of rules and regulations surrounding the release of medical records as related to patient privacy. Strong computer skills, including Microsoft Office products and ability to adapt to new systems. Strong communication skills: oral and written.
CentraState Healthcare System, a partner of Atlantic Health System, is a fully accredited, not-for-profit, community-based health system that provides comprehensive health services in the central New Jersey region. In addition to offering a full range of leading-edge diagnostic and treatment options, CentraState serves as a valuable health partner focused on the latest ways to prevent disease, promote healthy behaviors, and help people of all ages live life well. Based in Freehold, CentraState is comprised of a 284-bed acute-care hospital, a vibrant health and wellness campus, three award-winning senior living communities, a charitable foundation, and convenient satellite health pavilions offering primary care and specialty physician practices, along with access to outpatient services, such as lab and physical therapy. The system also offers a family medicine residency and geriatric fellowship training program in affiliation with Rutgers Robert Wood Johnson Medical School. Among its many honors and accreditations, CentraState is one of less than two percent of hospitals nationwide to earn Magnet® designation for nursing excellence four times and was designated a Great Place to Work-Certified™ Company by Great Place to Work® for the second consecutive year.
When you bring your talent to CentraState, you are joining a trailblazing healthcare facility, committed to providing high-quality, patient-focused care. Join us in making incredible strides in health care, and making a difference in our community. We believe in enriching the lives of our employees through work/life balance initiatives, tuition assistance, career advancement opportunities and much more.
Find out why our employees love their jobs and being part of the CentraState family!
What We Offer:
- Highly competitive compensation
- Excellent benefits package and rewards program
- 403(b) retirement plan with company match
- 401(a) retirement plan with employer contribution
- Life Insurance
- Tuition Reimbursement Program
- Profit Sharing Program
- Growth Opportunity and Workforce Development Initiatives
- Continuing Education / Onsite Training
- A warm, welcoming company culture based upon mutual respect and a collaborative goal of providing excellent patient care
- Concierge Services with Work & Family Benefits
- Magnet recognized healthcare facility
dividuals with disabilities to perform the essential functions.
CentraState Healthcare System prohibits discrimination based on arbitrary consideration of such characteristics such as race, color, religion, national origin, ancestry, gender (including pregnancy), affectual or sexual orientation, gender identity or expression, marital status, age, physical or mental disability or limitation, medical condition, genetic information, or veteran or military status, as well as any other legally protected class of persons and acts, in accordance with applicable State and Federal laws.
At CentraState, we welcome and promote the diversity of our employee family! Each unique person contributes to the overall success of this organization. Our inclusive culture fosters an environment of professionalism and respect for personal differences.
Additionally, CentraState Healthcare System prohibits discrimination based on arbitrary consideration of such characteristics such as race, color, religion, national origin, ancestry, gender (including pregnancy), affectual or sexual orientation, gender identity or expression, marital status, age, physical or mental disability or limitation, medical condition, genetic information, or veteran or military status, as well as any other legally protected class of persons and acts, in accordance with applicable State and Federal laws.