Summary: Leads and oversees the denial management processes for the Commercial Payer Team.
Other information: Minimum of two years of healthcare billing/collections or claims processing. Must be familiar with medical terminology, ICD9/ICD10 and CPT coding.Knowledge of managed care reimbursement methods, medical terminology, medical and healthcare billing and collections. Excellent analytical, organizational, and computer skills. Ability to communicate with public in a professional and courteous manner.
Responsibilities: Leads the denial management processes for the Commercial Payer Team. Prioritizes workflow, assigns duties, provides instruction and training, and monitors and reviews work to ensure high levels of productivity and quality. Analyzes and validates commercial denials. Researches denial criteria and compares to payer contract and benefits for appropriateness. Functions as liaison with clinical departments regarding denials. Provides formal and/or informal education to departments in an effort to reduce or eliminate denials. Provides weekly reports to department managers/designees of denial activity, and coordinates appeal decisions and supporting documentation. Initiates administrative appeals, to include writing appeal letters, and provides administrative support for medical necessity appeals. Recognizes and reports payer denial trends and issues to management, and makes recommendations for changes to reduce or eliminate denials. Recognizes, trends, and reports internal billing or coding issues resulting in denials. Possesses the ability to present information and recommendations accurately and effectively. Provides clear, concise, and timely documentation in the patient accounting computer system. Performs timely follow-up to appeals and responses from departments. Demonstrates proficiency with the following computer systems and applications: Patient Accounting, Microsoft Word, Document Imaging, Claims Editor, and RAS. Is proficient in navigating through payer web sites.
Competencies and skills: Essential: * Knowledge Of Office Equipment * Clear Communication Skills Both Written And Verbal * Knowledge Of Basic Computer Programs * Able To Keep Confidential Information Regarding Patients, Team Members * Able To Withstand Crisis Situations * Has Skills To Provides Customer Service To Patients, Team Members And Visitors * Experience With Excel, Power Point, Word, Visio, Etc.
Education: Essential: * High school graduate or equivalent
Beebe Healthcare serves the Sussex County community with a medical center located in beautiful, historic Lewes, Delaware, and convenient outpatient locations throughout the county. Founded in 1916 by two physician brothers, Drs. James Beebe and Richard C. Beebe, the medical center in Lewes is a 210-licensed-bed, not-for-profit seaside community hospital. Beebe's specialized service lines include cardiac and vascular, surgical services, oncology, women's health, and orthopaedic services. Beebe offers an array of inpatient, outpatient, emergency, and diagnostic services.
Beebe's five satellite campuses offer imaging, physical rehabilitation, and lab services, as well as walk-in care centers. In addition, Beebe offers Wound Healing & Hyperbaric Medicine and Diabetes Management & Medical Nutrition Therapy.
With a mission to serve the community, Beebe also offers many free screenings and outreach programs through its Population Health Department; and advanced medical care for those who are recuperating at home through Beebe Home Care Services.
Beebe is also training the next generation of nurses through the Margaret H. Rollins School of Nursing, located behind the Medical Cente...r in Lewes.
Beebe's Medical Staff has grown tremendously since the early 1990s. Employed physicians through Beebe Medical Group and our affiliated physicians on Beebe's Medical Staff now serve patients from Milford to Millville in specialties including cardiac surgery, dermatology, endocrinology, family practice, gastroenterology, general surgery, internal medicine, pediatric neurology, and surgical oncology.
Beebe is proud to offer quality care, close to home for the residents and visitors of Sussex County.