Summary of Job Function:

This Denials Patient Accounts Receivable Representative is primarily responsible for analyzing, researching and resolving assigned denials within set productivity measures to maximize accurate reimbursement and accelerate cash collections. The Denials Management Rep is expected to determine and execute the best approach for denial resolution and rebilling.

Job Specific Requirements

• Helps identify root causes associated with denials
• Analyzes and researches denials, follows-up with the payor/hospital department/patient to resolve denials
• Differentiates between clinical vs technical denials through EOBS, letters and data mining
• Identifies payer, UM agent and hospitals managed care contract governing clinical denial
• Reviews applicable timeframes governing the appeal process
• Contacts appropriate third party for outcome of clinical appeal
• Evaluates appeal outcome for next steps (logs recovered funds, supports uphold decision or initiates 2nd level appeal)
• Documents accurately and timely the follow-up requirement on denials
• Maximize utilization of Contract Management tools and efficient use of existing resources to support cash collection activities
• Develops and builds relationships with other hospital and CBO department to resolve denials and resubmit claims
• Trends payer issues, and reports them, including account examples, to the Supervisor timely
• Keep current with all government payor regulations and provider/payor contracts
• Act cooperatively and responsibly with patients, visitors, co-workers, management and clients.
• Maintaining unit/team specific productivity expectations per policy
• Adheres to department quality assurance expectations per policy
• Other duties as assigned

Job Requirements:

• BA/BS in business or related concentration, some college preferred
• Minimum 2 years experience in healthcare insurance collections field
• AAHAM(American Association of Healthcare Administrative Management) Certification preferred
• Proven knowledge and experience in hospital or physician patient accounting systems, preferably Siemens SMS and/or Affinity
• Experience working with customer support/client issue resolution management
• Benefits/fund administration experience preferred.
• Knowledge of/experience working with managed care contracts.
• Must be able to multi-task and work in a fluid and dynamic setting
• Excellent oral and written communications skills

-Demonstrated ability to work in a team environment that requires quick turnaround and quality output -Solid knowledge of all MS Office Products

We offer a great work environment, competitive rates and excellent benefits, including:

Medical/Dental/Vision plans

401 (k)

Vacation/Personal/Holiday/Sick Time Off

Short & Long Term Disability

Basic Life & Accidental Death Insurance

Tuition Reimbursement

Health Care/Dependent Care Flexible Spending Accounts

RWJBarnabas Health is the most comprehensive health care delivery system in New Jersey and the state s second largest private employer with more than 32,000 employees, 9,000 physicians and 1,000 residents and interns. The system includes eleven acute care hospitals, three acute care children s hospitals and a leading pediatric rehabilitation hospital (Children s Specialized Hospital).

RWJBarnabas Health is an Equal Opportunity Employer