Denials Specialist

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  Denials Analyst general responsibilities include denial follow up and research, appeals of insurance claims, working of undistributed dollars and credits in accounts, audit support and documentation research, insurance refunds and takebacks. This position will identify organizational reimbursement impact issues and opportunities to achieve optimum revenue collection for billed services. They will provide daily one-on-one staff education, Monthly presentations will be provided to the Denials Committee (Director level staff) to assist in the identification of lost revenue and opportunity to enhance the process. Quarterly PowerPoint presentations will be prepared and delivered to the Business Office staff to provide further guidance and education to enhance the staff effectiveness. Must have excellent customer service and communication skills. Must have demonstrated leadership skills.
  
  

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  Education and Experience:
  
  
  
  
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    Associates degree in healthcare or business administration and/or related coursework, or comparable experience of a minimum of three (3) years in a related healthcare field. Successful completion of data entry, general clerical, ten key, and denials specialist standards administered by Cuyuna Regional Medical Center Human Resources staff.
    
    
  
  
  
  
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  License/Certificates:
  
  
  
  
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    N/A
    
    
  
  
  
  
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  Special Skills and Aptitudes:
  
  
  
  
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    • Ability to work independently.
    • Ability to perform routine and complex procedures.
    • Ability to recognize problems, identify the cause and implement solutions.
    • Effective interpersonal relationship skills including good listening and communication skills.
    • Ability to handle confidential information discreetly and appropriately.
    • Ability to adapt resources to meet the needs of the situation.
    • Adjusts to stressful situations with confidence and good judgment.
    
    
    
    
  
  
  
  

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  1. Demonstrates proficiency in Medicare EDI system DDE.
  2. Reviews, researches and appeals denials of insurance claims.
  3. Works any undistributed dollars or credits in the patient accounting system.
  4. Reviews and researches insurance takeback requests or requests for insurance refunds.
  5. Provides assistance and documentation support during audits.
  6. Provides training education and feedback for Claims Analysts and other business office staff.
  7. Demonstrates excellent communication skills and customer service skills.
  8. Prepares and presents monthly presentations for the Denials Committee.
  9. Responsible, as assigned, to review and fix any claims edits or rejections.
  10. Responsible, as assigned, to do charge entry for correcting and/or adding charges.
  11. Responsible, as assigned, to void and repost charges when appropriate.
  12. Responsible, as assigned, to understand and comprehend the billing rules for provider based billing, rural health billing and CAH Method II billing.
  13. Responsible, as assigned, to prepare claims accurately to carriers and intermediaries in a timely manner.
  14. Responsible, as assigned, to follow-up on unpaid billed claims, and re-bill in a timely manner if necessary.
  15. Responsible, as assigned, to handle billing questions in a polite and professional manner and log patient complaints.
  16. Handles receipting of payments.
  17. Corrects registration errors and sends for needed billing information.
  18. May be required to work rotating shifts, weekends, and holidays. Ability to meet the scheduling needs of the department.
  19. Demonstrate Standards of Excellence when other duties are assigned.
  
  
  
  
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  Lead Responsibilities if applicable:

  
  

  
  
  • Direct and check the work of others.
  • Participate in the orientation and/or training of employees and provide feedback to management.
  • Coordinate the workflow among employees within the work area.
  • Provide technical or functional directions and support to employees.
  • Inform management on operational needs of the department.
  • Assist with the creation of work schedules.
  • Approve requests for time off, schedule changes, or additional ours/overtime and determine sick call replacement, according to a jointly pre-approved process, in the absence of a supervisor or manager.
  • Excellent Customer Service and communication skills are essential for the lead position.
  • Analyze and monitor all assigned work queues, identify error trends and develop training resources to improve accuracy.
  • Work closely with all Revenue Cycle staff to identify and create account accuracy improvement projects.
  • Serve as a communication liaison between revenue cycle staff for problem accounts and efficiencies.
  
  

  
  
  

  The pay range for this role is $22.65 to $27.48.

  Benefits
  
  Flexible schedule
  
  Competitive wages
  
  Medical, Dental, Vision, & Life insurance options
  
  HSA option
  
  401k contribution
  
  Scheduled every other weekend
  
  Paid Time Off

  
  

Why Cuyuna Regional Medical Center? CRMC provides the highest quality patient care by hiring exceptional, qualified individuals and providing opportunities for growth and advancement. We are more than 1,000 employees working in a unique environment that brings together the best in patient care and innovative medical specialties. From our expansive surgery suites with leading edge technology to our resort inspired senior living spaces, from trauma to routine, obstetrics to hospice, we provide services across the continuum of care - all in Minnesota's beautiful Brainerd lakes country. For more information about our medical campus visit: http://www.cuyunamed.org.

We offer a competitive compensation package, which includes exceptional benefits.

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Site Description: Crosby a city of 3,000 residents is part of the Brainerd and Cuyuna Lakes Area in central Minnesota. It is a top 5 destination in the United States for mountain biking. Crosby is just 15 miles from Brainerd, MN and a two-hour drive from Minneapolis/St. Paul. The Brainerd Regional Airport, which is serviced daily by Delta Airlines, is located 11 miles from Crosby. CRMC is located within a two-hour radius of Alexandria, Duluth, and St. Cloud.