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Beaumont Health System Denials Rep in Southfield, Michigan

divGENERAL SUMMARY: The 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.ESSENTIAL DUTIES:1. Understands the revenue cycle and the responsibility and goals of each area and how they impact the revenue cycle.2. Reviews 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.3. Documents all necessary elements; reason for denial/audit, denial status, action taken in the electronic medical record per denial management policy.4. Understands the current payer contracts.5. Applies corrections to patient demographics, charges, adjustments and payments or when needed forwards to the appropriate department for correction.6. Identifies and provides communication and education on trends identified on the monthly Denial Log.7. Appeals denials based on the appeal criteria found within the Denial Management policy and within appropriate denial due date timeframes.8. Works with facility departments when necessary for resolution or appeal of denials related to that department (i.e Lab, Patient Access, Case Management)9. Prepares and distributes a monthly denial log by facility to include account number, payor type, reason for denial.10. Identifies and communicates monthly denial trends and provides education as necessary to avoid recurring denials for the same denial reason code.11. Sends 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.12. Follows payor or contractor denial/audit rules and timelines as outlined. Performs appropriate follow up with payors on status of appeals/audits.13. Follows appropriate next steps when denial has been upheld and completes correct adjustment process after the first level of denial is upheld.14. Maintains a professional image and provides excellent customer service.15. Attends department meetings and education sessions.16. Meets/exceeds productivity and performance expectations within required timeframes.17. Practices and adheres to the "Code of Conduct" philosophy and Mission and Values statement.18. Adheres to all Beaumont Health Policies and Procedures.19. Performs other duties as assigned.STANDARD QUALIFICATIONSTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.A. uEducation / Training/u: Minimum of high school diploma or GED required.B. uWork Experience/u:Relative work experience in a health care-based setting preferred.Knowledge of Revenue cycle structure and process.C. uCertification, Licensure, Registration/u: HFMA CRCR certification within 6 monthsdiv/div/div