Denials Specialist

The Denials Specialist supports all denials management functions for Patient Financial Services. Maintains and updates denials management data and conducts initial analyses for trending and reporting. Responsible for conducting root-cause analysis of denials, interacting and meeting with departments throughout the hospital requiring assistance in addressing denials. Responsible for working denials assigned in work queues and accounts that are escalated to them for review and resolution. Works with PFS trainers to develop and maintain all denials management training and guidelines. This position requires strong partnering with management and staff in PFS, Ambulatory Services, Case Management, Patient Access, RAVE, Revenue Integrity and HIM in addition to departments across the system as needed. This position also requires working directly with payers to resolve accounts and work toward obtaining payments due.

Additional Information
Department Name: Patient Financial Services
Job Status: Full time, 40 hours per week.
Shift: Day 7am to 3:30pm, hybrid

Duties & Responsibilities

An employee in this position may be called upon to do any or all of the following essential functions. These examples do not include all of the functions which the employee may be expected to perform.

* Writes and sends detailed reconsiderations and/or appeals for LOMN, LOS, Additional information, other denials to payers; processing large volumes of denials and maintaining high quality work.
* Serves as escalation point to review and resolve escalated accounts and denial issues. Coordinates with internal teams.
* Recognizes deviations from contractual expectation and payer activities/decisions, recognizes gaps in payment/reasoning or system errors and takes appropriate steps to resolve.
* Drafts appeals for HMS, LIDS, Ceris and any other payer audits. Supports and completes audits as needed.
* Conducts root cause analysis for different account types to identify and solve gaps. Proactively solves reoccurring issues.
* Identifies and prioritizes account and work queues based on type, payer, dollar, etc.
* Utilizes multiple EMR platforms and payer portals to provide full-service account details to payers to obtain payment and account resolution.
* Investigates claim segments; identifies modifiers, taxonomy, and NPI concerns.
* Reviews contracts, contract summaries, payer policies to advise and apply correct applications for an account.

Minimum Qualifications

• Degrees
  • High School diploma or GED
• Experience
  • Three (3) years of healthcare or revenue cycle experience.

Salary Information
Pay is dependent on applicant's relevant experience.

Hourly Range: $24.01 to $36.02

Benefits Information
Here, you matter. As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.

EEO Statement
It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information. The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information.