Denials & Appeals Specialist

Mary Washington Healthcare
Full time Full day
Fredericksburg, VA
Start the day excited to make a difference…end the day knowing you did. Come join our team

Job Summary:



This position is accountable to perform all duties associated with the timely, accurate resolution of customer issues and questions within the Mary Washington Healthcare (MWHC) Customer Service department. The incumbent in this position will support the mission, vision, values and strategic initiatives of Mary Washington Healthcare and must demonstrate a commitment to quality service to patients, physicians, the public and co-workers


Essential Functions & Responsibilities:


  • Works proactively with multiple internal and external departments, including Patient Accounts and the Revenue Cycle, to ensure a reduction in denials, process improvement recommendations, and training/education occurs in a timely manner.

  • Assists in identifying and seeking resolutions to denials with the suitable resources.

  • Determines root causes and follows through with proper action steps based on the nature of the denials.

  • Assists in the weekly and monthly development of reports and/or graphs pertaining to quality assurance and denials management.

  • Works with appropriate departments to ensure reportable data is accurate and informative.

  • Assists in creating, updating, and distributing job aids for the appropriate staff in a timely and accurate manner.

  • Assists in the performance of one-on-one timely feedback of QA results with identified staff.

  • Supports team development and accomplishment of departmental goals and objectives.

  • Documents and communicates all trends to the Supervisor/Manager and makes recommendations of possible resolutions for those trends in an accurate and timely manner.

  • Understands MWHC billing and insurance reimbursement process.

  • Timely and appropriate response to phone calls, internal questions, and correspondence from various departments, outside agencies, and payers regarding information pertaining the resolution of denied claims.

  • Ensures confidentiality of privileged information.

  • Organizes job functions and work assignments to be able to effectively complete assignments within established time frames.

  • Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities.

  • Responsible for maintaining or managing time effectively to complete assignments within established time frames, optimize collections, and meet performance goals.

  • Maintains and projects a positive attitude and professional demeanor towards customers, co-workers and management that is consistent with MWHC culture.

  • Perform other duties as assigned.




Qualifications:


  • High school diploma or equivalent required.

  • Computer literacy including word processing, internet browsing, and spreadsheet programs required.

  • Minimum 5 years experience in medical insurance authorization, billing, patient accounts or related role required. Experience in denial and claims resolution required.

  • Certified Revenue Cycle Specialist (CRCS) or related industry certification preferred.

  • Able to work independently, paying particular attention to detail and following through with commitments and/or assignments.

  • Must demonstrate 30 WPM and be keyboard literate.

  • Knowledge of revenue cycle practices highly preferred.

  • Must demonstrate excellent verbal and written communication skills.




As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.

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