Medical Billing Claims Specialist - Conroe, United States - Aspire Hospital, LLC
3 weeks ago
Description
Job Overview:
At Aspire Hospital, the Denials Specialist is responsible for coordinating and monitoring the denial management and appeals process in a collaborative environment with revenue cycle management and clinical partners at various Aspire facilities
This position will be responsible for working assigned specialties and combines clinical knowledge to reduce financial risk and exposure caused by front end claim edits and retrospective denial of payments for services provided
This position will collaborate with physicians, revenue cycle personnel, and payers to successfully clear front end claim edits, appeal clinical denials, and address customer service inquiries
Communicates openly in a transparent and professional demeanor during all interactions with customers and co-workers while providing clear and concise communication of trending and findings to both front line team members and senior executives
Communicates to partners, revenue cycle staff, customers, and third party payers by telephone,
Functions as an educational liaison to clinical staff and revenue cycle staff as needed on payer denials, denial reason and trending, interpretation of payer manuals, medical policies, and local/national coverage determinations
Performs data mining and reporting activities that identify net positive impactful opportunities in denials and adjustments for the individual facilities and the system
Works assigned claim edit and follow up work queues and meets the assigned productivity standards on a daily basis as well as assigned patient account work queues and responds with resolutions within the expected time frame
Acts as a liaison for issues affecting various teams (coding, revenue integrity, accounts receivable (AR) follow up, etc.) of the revenue cycle while also providing support when IT related or systematic changes are needed
Analyzes data from various sources (medical records, claims data, payer medical policies, etc.), determines the causes for denials of payment and partners with management to implement strategies to prevent future denials
Integrates the payer medical policies, case specific medical documentation, and claims information into a concise appeal letter, including appropriate medical records submission
Performs timely review of medical records and remittances for denials in order to determine root cause and appropriateness
Partners with revenue cycle leadership and peers and clinical operations to reduce denials
This includes reviewing claim edits and denials and/or inquiries referred from other departments and assists in identifying root causes
Investigates the validity of the reasons for the denials and determines the need for or feasibility of submitting appeals
Works with revenue cycle management and staff to ensure claim edit/denial trending data is accurate and that all metrics are reported appropriately including specific current procedural terminology (CPT)/healthcare common procedure coding system (HCPCS), denial reasons, and appeals
Monitors recovery of payments and trends to identify corrective measures needed to prevent future edits/denials
Analyzes claim edits/denials to identify new trends, opportunities, and educational feedback as needed
This includes, but not limited to, feedback to coding, clinical service areas, physicians, and other revenue cycle staff
Makes recommendations to revenue cycle leadership on operations and root causes and assists in development of strategies to avoid future claim edits and denials
Provides education to revenue cycle team and attends monthly billing staff meetings as appropriate
This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned
Aspire Hospital reserves the right to revise job duties and responsibilities as the need arises
Qualifications:
High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
Five years of certified appeals denials or equivalent on the job experience
CERTIFICATIONS, LICENSES AND REGISTRATIONS
not requited but recommended
Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC), Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA), or an approved Specialty Society Coding Certification
Not required but prefered.
Demonstrates the ability to think critically, work independently, and be self-motivated for the role
MUST HAVE
Experience with computer database management and Microsoft Office software
Preferred but not required
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
Work setting:
- Office
Work Location:
In person
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