Title: Insurance Denials Specialist Job Code: 800300
Department/Location: Pt Accounts FLSA Status: Non Exempt
Reports to: Manager, Pt Accounts
Position Summary
The Denials Specialist is responsible for providing various support within the Medical (Hospital Centralized Business) Billing
Department. This position involves collecting and managing accounts, following up with insurance companies, reconciling accounts,
filing corrected claims, appealing claims when appropriate, and following up on all denials to ensure reprocessing and payment in a
timely manner.
Essential Functions and Responsibilities Includes the Following:
1. Understands and adheres to the WPH Performance Standards, Policies and Behaviors.(Process rejections, denials and other
correspondence received from third party payers in accordance with WPH procedure.s and guidelines in an effort to resolve
non-payment issues and rebill "clean" claims for payment.
2. Document accounts worked in Davincian/Meditech.
3. Responsible for the submission of appeals to third party payers in recover additional revenue
4. Investigate payer rejections and denials.
5. Work all Denials that pertain to including but not limited to, Duplicate Claim, Timely Filing, EOB requests, Not Medically
necessary denials, COB denials.
6. Responsible for reviewing and trending of denial issues, identify root cause and bring accounts to final resolution.n
7. Communicate information and make recommendation to improve current processes to eliminate future denials occurrence.
8. Performs all other related duties as assigned.
Education & Experience Requirements
High School Graduate required. Clerical Experience.
Previous hospital billing/follow up/denials experience required.
Ability to use basic office equipment and knowledge of CTR computer terminals required.
Medical terminology helpful but not mandatory.
Core Competencies
Ability to cooperate with others.
Must be able to speak, write understand and communicate the English language.
Effectively communicate with internal and external customers.
Integrity to handle the confidential aspects of work.
Retains composure under stress
Physical/Mental Demands/Requirements & Work Environment
May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may
be exposed to are listed in the hospital's SDS (Safety Data Sheet) data base and may be accessed through the
hospital's Intranet site (Employee Tools/SDS Access). A copy of the SDS data base can also be found at the
hospital switchboard, saved on a disc.
"Must be able to remain in stationary position 50% of the time
"The person in this position needs to occasionally move about inside the office to access file cabinets, office
machinery, etc
"The person in this position frequently communicates with patients who have questions, must be able to exchange
accurate information in these situations
"Must be able to detect and greet patients arriving
Primary Population Served
Check appropriate box(s) below:
Neonatal (birth - 28 days) Patients with exceptional communication needs
Infant (29 days - less than 1 year) Patients with developmental delays
Pediatric (1 - 12 years) Patients at end of life
Adolescent (13 - 17 years) Patients under isolation precautions
Adult (18 - 64 years) Patients with cultural needs
Geriatric (> 65 years) All populations
Bariatric Patients with weight related comorbidities Non-patient care population
The responsibilities and tasks outlined in this are not exhaustive and may change as determined
by the needs of White Plains Hospital.
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