Denials Management Assistant, Part Time

Job description

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. Denials Management Assistant provides administrative and clerical support for the denials and appeals team by preparing, organizing, and submitting all levels of appeal documentation to payers within required timeframes. This role ensures accuracy, timeliness, and completeness of appeal packets and assists in tracking appeal outcomes to support the organization’s revenue recovery efforts. Also, maintaining good documentation in the appropriate systems and good communication between the Denials Management Manager, and Denials Management Team members to facilitate appeal letter responses throughout all levels of determination. In addition to the primary role, the liaison may also perform data abstraction and entry as related to the Denials Management Program outcomes, assist with preparing denial reports. This position reports to the Manager of the Denials Management Program. JOB DUTIES AND RESPONSIBILITIES: Assemble and submit first-level, second-level, and external appeals for medical necessity, technical, and authorization denials. Confirm all data (Payer, Patient and DOS) information is accurate on the appeal letter. Act as a final quality check point for appeal integrity. Work all WQs including Correspondence WQ in a timely manner. Prioritize by due date. Retrieve DS RN information (RN appeal to send list). Check for RN notes for any priority cases. Send medical record requests for the cases the DS RN sent with appropriate payer form (hard copy, CD, electronic). Ensure all required documents (medical records, physician statements, clinical criteria, appeal letters, and forms) are included and correctly formatted. Submit appeals via the required payer method: fax, certified mail, payer portals, or electronic systems within payer deadlines. Retrieve and organize clinical documentation from EMR systems. Maintain accurate logs of appeal submissions, tracking dates, payer responses, and outcomes. File and store appeal documents per HIPPA and organizational policies. Collaborate with RN appeal writers, and coordinator to ensure appeal packets are complete. Communicate with payers and confirm receipt and status of submitted appeals. Notify appeal writers or leadership of upcoming deadlines or missing information. Follow established procedures and payer-specific requirements for each appeal level. Ensure appeal content adheres to regulatory standards, including HIPAA compliance. Assist with internal audits, reporting, and data entry as requested. Maintain open communication between Denials Management Manager, Physician Advisor, Case Management Director, along with other associated departments. Assists in preparing reports regarding denials to include volumes, number of appeals, case resolution, and impact on revenue and trending. Maintains confidentiality of all materials handled within the Network/ Entity as well as the proper release of information. Complies with Network and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements. Demonstrates/models the Network’s Service Excellence Standards of Performance in interactions with all customers (internal and external). Demonstrates Performance Improvement in the following areas as appropriate: Clinical Care/Outcomes, Customer/Service Improvement, Operational System/Process, and Safety. Demonstrates financial responsibility and accountability through the effective and efficient use of resources in daily procedures, processes, and practices. Complies with Network and departmental policies regarding attendance and dress code. Other related duties as assigned. PHYSICAL AND SENSORY REQUIREMENTS: Sitting for one to two hours at a time, stand for two to three hours at a time, walk on all surfaces for up to five hours per day, and climb stairs. Must be capable of driving a car. Fingering and handling objects frequently. Occasionally firmly grasp, twist, and turn objects weighing up to 75 pounds. Occasionally stoops, bends, squats, kneels, and reaches above shoulder level. Must have the ability to hear as it relates to normal conversations and high and low frequencies, and to see as it relates to general and peripheral vison. Must have the ability to touch as related to telephone and computer keyboard. EDUCATION: Associate Degree in Business or Secretarial Field preferred, or High School Diploma with courses in Medical Terminology preferred. TRAINING AND EXPERIENCE: Three to five years related health care experience. Proficiency in Microsoft Word/Windows, Excel, and the ability to learn how to work in multiple computer software systems. Ability to enter data and manage data base with 100% accuracy. Ability to work within strict deadlines. Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!! St. Luke's University Health Network is an Equal Opportunity Employer.