Denial Appeals Specialist Full Time - Patient Financial Services

New City, New York Department

Patient Financial Services_2 Work Shift

Day Work Days

MON-FRI Scheduled Hours

8 AM-4:30 PM Scheduled Daily Hours

8 HOURS Scheduled Weekly Hours

40 Hourly Rate/Range

Starting at $24.00

For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

Job Summary: The denial appeals specialist is accountable for carrying out and documenting the appeals process for denied claims at Nyack Hospital. The specialist also works to maintain third-party payer relationships, a role that consists of responding to inquiries, complaints, and other correspondence. They will also work with vendors who process denials on Nyack Hospital’s behalf supplying any needed information or documentation. They will assist Infusion services Billing Coordinator with coding and charging for services rendered. The specialist will consistently and accurately review and translate clinical documentation and medical records into different ICD-9, ICD-10 and CPT codes as needed per denial.

B.Essential Job Qualifications

1. Education: High School Diploma required; Associates preferred
2. Experience: Minimum 2 years experience in healthcare coding required. Billing experience required, PC knowledge required.
3. Training/Certification: CPC or CCS required
4. Licensure: N/A
5. Other: Knowledge of state/federal laws that relate to contracts and to the appeal process is vital. Regularly makes complex decisions within the scope of the position, and is comfortable working independently.

Job Specific Contacts

General Contacts: Patients, family members, insurance carriers, banks, employers, physicians, physician’s office staff, hospital personnel, Dept of Social Services employees, Third Party vendor representatives Job Provides Direction to : N/A

D.Environment and Demands

Environmental Demands: Describe the physical environment in which the job must be performed.

Business Office environment, hospital rooms, Department of Social Services. Requires light physical effort on a regular basis, as in viewing CRT, frequent standing, walking, bending, stooping or reaching and/or occasional lifting of light items. Some minor physical inconvenience or discomfort routinely present in the work situation and occasional exposure to minor injury or other occupational hazards requiring Universal Precautions.

1. Essential Physical and Cognitive Demands, Manual Dexterity: : Describe the physical efforts, manual dexterity and cognitive skills required for the job ( i.e. , eye/hand coordination, lifting, pulling, walking, concentration, analysis, customer sensitivity, etc.).

Requires light physical effort on a regular basis , as in viewing CRT, frequent standing, walking, bending, stooping or reaching and/or occasional lifting of light items (i.e., up to 20 lbs.). Some irregularity in scheduled hours because of compensated overtime requirements, including weekend and/or other shift rotation. Interaction with patients and public.

Part I: Hospital-Wide Standards

A. Organizational

Demonstrates adherence to Nyack Hospital “We Care” standards including

WORKING TOGETHER “ I will commit to work together in a courteous, respectful manner. I will demonstrate a positive spirit of service with all employees with whom I interact.”

I will

• Place team success above individual recognition.
• Be receptive to new ideas and approaches within my workplace.
• Offer assistance generously without hesitation.

EMPOWERMENT “I will be accountable, responsible, and self-directed in all aspects of my work at all times.”

I will

• See projects through to ensure completion.
• Problem solve with patients, family members, and other employees.
• Follow up to ensure a resolution.

COMMUNICATION “I will demonstrate positive communication in a clear, courteous and appropriate manner at all times.”

I will

• Use effective verbal and written communication to patients, families, visitors, and fellow employees using the principles of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You)
• Use positive communication in my tone of voice, body language, and choice of words.

APPEARANCE “I will dress in a manner that reflects a professional and positive image of the hospital at all times”

I will

• Maintain a clean, neat, and professional appearance.
• Adhere to the Hospital's dress code policy.
• Promote and adhere to Nyack Hospital's guidelines regarding a safe and clean work environment for employees, patients and visitors.

RESPONSIVENESS “I will demonstrate the ability to provide timely feedback and communication to patients, visitors, and coworkers.”

I will

• Respond empathetically.
• Apologize for delays and concerns.

EXCELLENCE IN SERVICE “I will strive to ‘do my best everyday’ in exceeding customer expectations.”

I will

• Anticipate and address my patients’ and customers’ needs.
• Avoid negativity and exhibit a “can-do” attitude.
• “Manage up” fellow employees, physicians, departments, and the organization, to increase patient confidence both internally and in the community.

B. MISSION/STRATEGIC PLAN

Participates in activities which support the mission of the hospital

C. JOB SPECIFIC COMPETENCIES

Demonstrates the required job specific technical/professional knowledge, skills and abilities. *

• Assist Infusion services Billing Coordinator with coding and charging for services rendered
• Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to, and/or resolving appeals with third party payers in a timely manner
• Tracks the status and progress of appeals and maintains well-organized records to ensure established timelines are met
• Conducts internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations
• Works with internal departments and external organizations to resolve appeals
• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members and supervisor to make recommendations for improvement and resolve issues
• Prepares, maintains, assists with, and submits reports as required
• Regularly makes complex decisions within the scope of the position, and is comfortable working independently
• Collaborates with team members to continually improve services, and engages in process and quality improvement activities
• Demonstrates teamwork and integrity in all work-related activities
• Complies with state and federal regulations, accreditation/compliance requirements, and Nyack Hospital’s policies, including those regarding fraud and abuse, confidentiality, and HIPAA
• Participates in professional development to enhance job knowledge and performance
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms
• Code ICD-9, ICD-10, and CPT codes for infusion services
• Communicate with Patients and Physicians office as needed
• Performs special projects and other duties as assigned

Montefiore Nyack Hospital is an equal employment opportunity employer. Montefiore Nyack Hospital will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.