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Beaumont Health System Denials Rep in Southfield, Michigan

div divdivdivbspanspanGENERAL SUMMARY: /span/span/bspanspanThe Denials Analyst will be responsible for reviewing, researching and taking the next step based on the type of denial and protocol for the denial type. The Denials Analyst will provide a detailed monthly denial summary for each Beaumont Health facility. This position reports to the Manager, Denials. /span/spanbspanspan /span/span/bbspanspanESSENTIAL DUTIES:/span/span/b ollispanspanspanspanUnderstands the revenue cycle and the responsibility and goals of each area and how they impact the revenue cycle./span/span/span/span/lilispanspanspanspanspanspanspanReviews all accounts that have has a payer denial based on the Denial Management Policy and Procedure and take appropriate action based on the type of denial./span/span/span/span/span/span/span/lilispanspanspanspanspanspanspanDocuments all necessary elements; reason for denial/audit, denial status, action taken in the electronic medical record per denial management policy./span/span/span/span/span/span/span/lilispanspanspanspanspanspanspanUnderstands the current payer contracts./span/span/span/span/span/span/span/lilispanspanspanspanspanspanspanApplies corrections to patient demographics, charges, adjustments and payments or when needed forwards to the appropriate department for correction./span/span/span/span/span/span/span/lilispanspanspanspanspanspanspanIdentifies and provides communication and education on trends identified on the monthly Denial Log./span/span/span/span/span/span/span/lilispanspanspanspanspanspanspanAppeals denials based on the appeal criteria found within the Denial Management policy and within appropriate denial due date timeframes./span/span/span/span/span/span/span/lilispanspanspanspanspanspanspanWorks with facility departments when necessary for resolution or appeal of denials related to that department (i.e Lab, Patient Access, Case Management)/span/span/span/span/span/span/span/lilispanspanspanspanspanspanspanPrepares and distributes a monthly denial log by facility to include account number, payor type, reason for denial. /span/span/span/span/span/span/span/lilispanspanspanspanspanspanspanIdentifies and communicates monthly denial trends and provides education as necessary to avoid recurring denials for the same denial reason code./span/span/span/span/span/span/span/lilispanspanspanspanspanspanspanSends identified medical records as part of the denial/audit process via variety of methods- expedited mail, electronic portal, payor portal or expedited ground currier service. Documents appeal/additional documentation was sent in the electronic medical record once completed. /span/span/span/span/span/span/span/lilispanspanspanspanspanspanspanFo