Denial Management Specialist

Denial Management Specialist

Everything we do is underscored by a why — and that why is one another.

Location: Altru Health System PO Box 6002 Grand Forks, ND 58201 Pay Range: $17.07 - $25.60

Summary:

The Denial Management Specialist is responsible for managing and filing appeals to reverse denials, collaborating with departments to resolve issues and identify trends, and staying updated on payer guidelines and requirements for denials and appeals. The position involves monitoring RAC accounts for adjustments, analyzing denial trends, and exhausting all appeal efforts according to payer guidelines. The role also includes providing feedback to leadership, participating in continuing education on payer policies, and ensuring accurate account adjustments. Effective communication, confidentiality, and adherence to privacy standards are essential aspects of this position.

Essential Job Functions:

• Manages and file appeals to reverse denials wherever possible.
• Works on assigned denials and appeals by collaborating with departments to resolve issues and identify trends.
• Stays updated on payer guidelines and requirements for denials and appeals.
• Monitors RAC accounts for AB rebills and post recovery or denial adjustments as needed.
• Identifies and address issues from denials to prevent future claim problems and analyzes denial trends and issues as assigned.
• Exhausts all appeal efforts based on dispute reasons and payer guidelines.
• Provides feedback and recommendations to leadership on trends, escalating issues when necessary.
• Participates in continuing education on payer and governmental policies, sharing updates with leadership and Patient Financial Services.
• Monitors appeals for resolution and adjust accounts using correct denial codes and recognizes when to escalate unresolved denials.
• Maintains strict confidentiality and adheres to all employer and government privacy standards, e.g., 42 CFR part 2 and HIPAA
• Performs other duties as assigned or needed to meet the needs of the department/organization.

Work Experience:

• Required: A minimum of 2 years Related Experience

Language Requirements:

This position requires proficiency in reading, writing, and speaking English to ensure effective communication in the workplace and with patients, families, and team members.

Physical Demands :

• Sit: Frequently (34-66%)• Stand: Occasionally (5-33%)• Walk: Occasionally (5-33%)• Stoop/Bend: Rarely (1-4%)• Reach: Frequently (34-66%)• Crawl: Not Applicable• Squat/Crouch/Kneel: Rarely (1-4%)• Twist: Occasionally (5-33%)• Handle/Finger/Feel: Continuously (67-100%)• See: Continuously (67-100%)• Hear: Continuously (67-100%)

Weight Demands:

• Lift -Floor to Waist Level: Sedentary (<10 pounds)• Carry: Sedentary (<10 pounds)• Push/Pull: Sedentary (<10 pounds)• Slide/Transfer: Not Applicable

Working Conditions:

• Indoor: Continuously (67-100%)• Outdoor: Not Applicable• Extreme Temperature: Not Applicable

Driving Requirement Definitions:

• Professional Drivers: Persons who drive as their main responsibility OR transport passengers or hazardous materials.
• Frequent Drivers: Persons whose main responsibility is not driving, but drive daily or almost daily.
• Occasional Drivers: Persons who drive from once per month to as frequently as once per week.
• Infrequent Drivers: Persons who are generally not expected to drive.

Driving Requirement for this position:

Infrequent Driver

Making a real difference. For one another.

To take the best care of our patients and community — including friends, family, and neighbors — we need people who are committed to growth, excellence, and one another.

At Altru, you'll find a culture where support and teamwork are at the heart of what we do. You'll have opportunities to advance your skills, work with the latest technologies, experience the fulfillment that comes from giving back, and take your career wherever you want it to go.

Join our team and be a part of a small community with a big heart.

Altru offers a comprehensive benefits package to its full- and part-time employees. Excellent benefits include a health plan and 401(k) retirement plan. Other benefits include a dental plan, vision plan, life and disability insurance, education assistance, paid time off (PTO)