Denial Resolution Specialist, Outpatient Behavioral Health - Harrington Southbridge Campus - 40 hours, Days

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Exemption Status

Non-Exempt

Hiring Range

$0.00 - $0.00 Please note that the final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations .

Schedule Details

Monday through Friday

Scheduled Hours

8a-4:30p

Shift

1 - Day Shift, 8 Hours (United States of America)

Hours

40

Cost Center

• 25080 - 1908 Psychiatry Administration
• This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Responsible for reviewing, analyzing and initiating appropriate action for denial resolution by communicating with payers, hospital

departments and patients for data as assigned.

Major Responsibilities

1. Completes appropriate actions needed for an effective appeal including conducting authorization research, rebilling, and balance write off

or transfer to next responsible party. Escalates issues as appropriate.

1. Corresponds with third party payers, hospital departments, and patients to obtain information required for denial resolution following payer

timelines. Releases information following Federal, State and Hospital guidelines.

1. Uses assigned work queues and prioritization standards and guidelines to perform denial resolution follow up.
2. Uses reference material to troubleshoot payer issues and increase understanding of denial resolution techniques. Reference payer

websites as needed.

1. Analyzes and researches the denial reasons for each assigned denial code.
2. Determines and executes the best approach for denial resolution utilizing all available resources.
3. Follows payers established procedures and timelines to submit appeals utilizing payers preferred method, i.e., electronically or via paper.
4. Documents all actions taken during the denial resolution process clearly including actions taken, next steps, payer processing timelines,

etc.

1. Adjusts account balances using correct transaction code adhering to established departmental policies.
2. Follows established protocols to ensure all documents are retained appropriately
3. Meets established quality and productivity standards.
4. Facilitates and promotes the sharing of knowledge and content throughout departments.
5. Follows all established Hospital Billing Revenue Cycle Management departmental and compliance policies and procedures.
6. Participates in cross training of billing resources.
7. Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
8. Maintains and fosters an organized, clean, and safe work environment.
9. Contributes to the development and application of process improvements. Practices cost containment and fiscal responsibility through

the efficient use of supplies, equipment, time, etc.

II. Position Qualifications

License/Certification/Education

Required

1. High School diploma

Experience/Skills

Required

1. Previous Revenue Cycle knowledge in one of the following areas including PFS, Customer Service, Cash Posting, Financial Assistance,

Patient Access, HIM/Coding and/or 3rd party Reimbursement.

1. Ability to perform assigned tasks efficiently and in timely manner.
2. Ability to work collaboratively and effectively with people.
3. Exceptional communication and interpersonal skills.

Preferred

1. One or more years of experience in health care billing functions and with EPICS experience.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.