Denials Appeal Rep TC

Summary:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">The Denial Appeal Representative
reports to the Patient Financial Services Technical Appeals Supervisor.  Under general direction and within
established Lifespan policies and procedures performs all
administrative/clerical support duties needed to maximize reimbursement from
contracted payers.  Executes the appeal
process by receiving assessing documenting tracking analyzing responding
to and and/or resolving appeals with third-party payers. Uses available metric
denial reports to analyze track and trend denials using available metric
denial reports. Processes a thorough understanding of all aspects of claim
related errors and the ability to adjust or changes related to denials as
needed within the scope of job function. 

Responsibilities:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Consistently applies the
corporate values of respect honesty and fairness and the constant pursuit of
excellence in improving the health status of the people of the region through
the provision of customer-friendly geographically accessible and high-value
services within the environment of a comprehensive integrated academic health
system.  Is responsible for knowing and
acting in accordance with the principles of the Lifespan Corporate Compliance
Program and Code of Conduct.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Provides administrative/clerical
support to the denials appeals process which includes receiving assessing
documenting tracking responding to and /or resolving denials with third
party payers in a timely fashion.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Ability to process and organize a
large volume of record requests document scanning telephone calls electronic
record documentation requirements.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Evaluates denied accounts sent to
the Denials Management Department for review. Assigns denied accounts to
appropriate department work queues for resolution. Identifies repetitive issues
with the goal of identifying preventative solutions. Uses reports and work
queues to identify accounts not worked in a timely manner and follows up with
clinical and financial departments when this occurs.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Tracks the status and progress of
appealed activity and payer appeal responses using work queues and
well-organized records to assure established timelines are met.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> Researches payer issues resulting in payment
delays denials underpayments and processing deficiencies and recommends
changes as appropriate. Review monthly payer updates that will be reported
during the monthly Appeal/Denial meeting. 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Maintain a strong collegial
working relationship with payers to assure claims/appeals are processed
appropriately.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Processes necessary Lifechart
online adjustments or changes related to appeals as needed within the scope of
job function.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Continually evaluates work flow
and identifies opportunities to improve process for full and complete payment
for all hospital services rendered to patients to include the need for system
updates after careful analysis.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Creates generates and maintains
ad hoc reports as requested by Manager to assist in the daily operation of the
department.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Participates in staff meetings
councils quality improvement teams and other such meetings and committees as
required.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Develops and maintains working
relationship with Lifespan affiliate departments as needed to ensure full data
exchange.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Performs other duties as
necessary.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
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mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">WORK LOCATIONS/EXPECTIONS:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">After orientation at the
Corporate facilities work is performed based on the following options approved
by management and with adherence to a signed telecommuting work agreement and
Patient Financial Services Remote Access Policy and Procedure..

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">�             Full
time schedule worked in office

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">�             Full
time schedule worked in a dedicated space in the home

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">�             Part
time schedule in office and in a dedicated space within the home

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Schedules must be approved in
advance by management who will allow for flexibility that does not interfere
with the ability to accomplish all job functions within the said schedule.  Staff are required to participate in
scheduled meetings and be available to management throughout their scheduled
hours.  Staff must be signed into
Microsoft Teams during their entire shift and communicate with Supervisor as
directed.

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Other information:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">BASIC KNOWLEDGE:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
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mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">High School Graduate or
equivalent. Experience and knowledge in hospital patient accounting or
denials/appeals in similarly complex healthcare organization.  Must be familiar with ICD-9/10 CPT-4 coding
UB04 and HCFA 1500 claims administration. Demonstration of highly developed
organizational ability communication skills and problem-solving skills.

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">EXPERIENCE:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
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mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Three to five years� experience
and knowledge in hospital patient accounting or denials/appeals in similarly
complex healthcare organization.  Must be
familiar with ICD-9/10 CPT-4 coding and Microsoft Office tools UB04 and HCFA
1500 claims administration.  Ability to
perform financial analysis. 
Comprehensive knowledge of patient accounting activities in an
automated networked multiple hospital environment.  Detailed knowledge of regulatory requirements

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">INDEPENDENT ACTION:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">Incumbent functions independently
within scope of department policies and practices; refers specific problems to
supervisor only when clarification of departmental policies and procedures may
be required.

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mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">SUPERVISORY RESPONSIBILITIES:

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1"> 

mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-theme-font:
minor-latin;color:black;mso-themecolor:text1">None.

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.

Location: Corporate Headquarters USA:RI:Providence

Work Type: Part Time

Shift: Shift 1

Union: Non-Union