Denials Management Specialist (40hrs/week, 1st shift)
Company: Lancaster General Health
Posted on: November 11, 2019
CompanyLancaster General Medical GrpCost Center61020 PBS-Account
ResolutionSupervisory OrganizationProfessional Billing Services
Account ResolutionGradeG07SummaryPOSITION SUMMARY: Maximizes cash
collections and resolution of aged accounts through informed,
consistent follow up activities. Responsible for the timely billing
and follow-up of assigned accounts and for ensuring all accounts
are paid correctly according to insurance contract terms.?
Consistently identifies account deficiencies that require
subsequent follow-up and ensures all deficiencies are resolved.?
Escalates issues to supervisor and tracks data for trending and
feedback purposes.? Works within a structured team setting to
ensure team goals and well as individual goals are met in an
appropriate manner.ESSENTIAL FUNCTIONS: Qualified individuals must
have the ability (with or without reasonable accommodation) to
perform the following duties:
- Analyzes and researches denials and follows-up with the
appropriate payor, practice, and/or patient to resolve denial.
Provides missing or additional information if necessary, to
expedite the resolution of the denied claim.
- Performs all appeals and denial recovery procedures needed to
appropriately and accurately resolve denied claims.?
- Processes required adjustments to accounts, including charges
credits, payment transfers, policy adjustments, etc. in a timely
and accurate manner.
- Maintains a thorough knowledge and understanding of all
assigned payor contracts and requirements.
- Performs research to ensure current policies, applicable coding
and insurance guidelines, regulations and laws are being
- Evaluates processes and procedures and makes practical
suggestions/recommendations for improvement or compliance.
- Prepares accurate and timely reports of trends and problems as
they are identified. Communicates such trends to management in a
- Consistently identifies account deficiencies that require
follow up and ensures that appropriate actions have occurred.
- Completes work accurately and timely with appropriate
- Ensures that all activities related to denials management
functions meet department requirements, maximize revenue
collection, and achieve leading practice levels of
- Consistently meets productivity and quality standards
established by management, recommending new approaches for
enhancing performance and productivity when appropriate.
- Keeps Supervisor/Manager informed of any problems or
issues.SECONDARY FUNCTIONS: The following duties are considered
secondary to the primary duties listed above:
- Provides timely billing and follow-up of assigned inventory for
the purpose of expediting timely account resolution.
- Updates patient accounts to reflect any changes made to
- Contacts payers, employers, customers, attorneys, etc. in an
effort to expedite the payment of accounts.
- Processes and follows special accounts for resolution.
- Assists with any special projects as assigned.
- ?Other duties assigned.JOB REQUIREMENTSMINIMUM REQUIRED
- High School diploma or equivalent.?PREFERRED QUALIFICATIONS:
- Associate?s degree
- Strong written and verbal communication skills.
- Microsoft Office experience.
- Strong organization skills.
- Ability to apply strong analytical qualities.
- One (1) to two (2) years of experience in hospital or physician
billing/insurance follow up.COGNITIVE
REQUIREMENTSATTENTION/CONCENTRATION ? The following level of
ability is essential for the jobholder to focus on certain aspects
of current experience and reject others:
- The position requires the ability to attend to more than one
aspect of a situation simultaneously.? It is highly likely that
multiple task demands are going to be required of the individual at
the same time.NEW LEARNING AND MEMORY ? The following level of
ability is essential for the jobholder to learn and retain
- Job demands are only moderately routine and predictable.? Minor
changes may occur which require the individual to be able to
understand and carry out detailed but uninvolved
instructions.PROBLEM SOLVING, REASONING AND CREATIVE THINKING ? The
following level of ability that is essential for the jobholder to
think (in order to solve a problem) by combining two or more
elements from past experience or imaginative thought:
- The position deals with issues or problems that often require
thoughtful reasoning before arriving at approaches or solutions.?
Some independent thought, planning or origination of options and
solutions is necessary.? The individual must have the ability to
apply principles of reasoning and problem solving to resolve
practical problems and deal with a variety of concrete variables in
situations where only limited standardization exists.APTITUDES:?
The following are essential requirements of the position in
relation to job-worker situations.? These items describe how a
worker must adapt, adjust, conform or act:Leadership, control and
planning: Ability to accept responsibility for leadership,
direction, control, planning, negotiating, organizing, directing,
supervising, formulating practices, or making final
decisions.Repetitive work: Ability to continuously perform the same
type of work for extended periods of time, according to set
procedures, sequence or pace.Performing under stressful conditions:
Ability to perform under stress when confronted with emergency,
critical, unusual, or dangerous situations, or in situations in
which working speed and sustained attention are critical aspects of
the job. Is subject to danger or risk, or to tension as a regular,
consistent part of the job.Variety and change: Ability to perform a
variety of duties, often changing from one task to another of a
different nature without loss of efficiency or composure involving
significant differences in technologies, techniques, procedures,
environmental factors, physical demands, or work
situations.Communication:? Ability to exchange information with
others clearly and concisely; to present ideas, facts and technical
information.Interpersonal relations: Ability to maintain
relationships that facilitate task accomplishment; to cooperate and
resolve conflicts; to recognize needs and be sensitive of
others.EQUIPMENT USAGE REQUIREMENTS Equipment/Tools: Computer,
Phone, Copier, Printer, Fax, Office SuppliesSoftware: Microsoft
Office Products, EPICPHYSICAL REQUIREMENTSRarely 0-10%;
Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%Body
- Sit: Frequently
- Stand: Occasionally
- Walk: Frequently
- Bend: Occasionally
- Push: Rarely
- Pull: Occasionally
- Kneel/Squat: Occasionally
- Reach: Occasionally
- Twist: Rarely
- Balance: Rarely
- Climb: OccasionallyLifting: Degree of physical exertion
is:Moderate, exerting up to 20 pounds of force occasionally, and/or
up to 10 pounds of force frequently, and/or a negligible amount of
force constantly to move objects.Sensory Abilities specifically
- HearingPHYSICAL ENVIRONMENTWORKING CONDITIONS: Exposure to
hazardous conditions/ materials is
negligible.???????????????????????????????????Disclaimer: This job
description is not intended and should not be construed to be an
exhaustive list of all responsibilities, skills, efforts, or
working conditions associated with the job.? It is intended to be a
reflection of those principal job elements essential for
recruitment and selection, for making fair job evaluations, and for
establishing performance standards.? The percentages of time spent
performing job duties are estimates, and should not be considered
absolute.? The incumbent shall perform all other functions and/or
be cross-trained as shall be determined at the sole discretion of
management, who has the right to amend, modify, or terminate this
job in part or in whole.? Incumbent must be able to perform all job
Keywords: Lancaster General Health, Lancaster , Denials Management Specialist (40hrs/week, 1st shift), Executive , Lancaster, Pennsylvania
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