Revenue Cycle - Denials Analyst in Winner, South Dakota at Winner Regional Healthcare Center

Position Summary:

The Denials Analyst position will work collaboratively with the Revenue Cycle teams to recover complex aged accounts and denials by doing account and denial follow-up. This position will also help identify and report any denial/non-payment trends or software issues to the Director of Revenue Cycle in an effort to correct issues that may be hindering clean claims going to payers or hindering prompt payment. This role is built for someone who is fast paced, loves digging in and untangling denials, thrives on collaboration and enjoys a good challenge. Remote possibility for the right driven, self-directed, trustworthy applicant.

Education/Experience:

Associates Degree or equivalent combination of education and experience in lieu of degree.

3+ years in hospital billing, denials, appeals, and collections.

Ability to comprehend payer 835 and paper remits and knowledge of CARC/RARC codes/denial reasons.

Understanding of CCI edits, CPT, HCPCS, ICD-10 and Revenue Codes.

Strong PC skills (Windows/Microsoft products) and eagerness to adopt new revenue cycle platforms and analytics tools.

Exceptional organization, deadline ownership, and a “no claim left behind” mentality.

Experience with Epic EMR (HB) preferred.

Positive outlook and excitement to learn new things as healthcare is everchanging.

Required Credentials (Licensure, Certification, or Registration):

None required

Employment Variables:

Normal working hours are eight-hour days, Monday-Friday, 8am – 5pm. Initial Tuberculosis (TB) test and drug screening is required by Winner Regional Health. Rubella titer will also be drawn upon hire and immunization is required if no past exposure or indication of immunization.

Required to wear name tag provided by WRH and to follow the dress code of WRH (if onsite).

Job Knowledge and Skills:

Knowledge of claims, codes, payer billing rules/regulations, and denial/follow-up processes in a healthcare facility preferred. Ability to read, write, speak and understand the English language. Excellent oral and written communication skills. Ability to virtually attend meetings/discussions in a professional manner and display a professional image. Knowledge of computer and general office equipment.

Direct Supervisor:

Revenue Cycle Director

PART II: CODE OF CONDUCT

Function Explanation

Honesty - We will do the right thing at all times, even if it is difficult, maintaining strong, ethical practices. We protect the confidentiality of others, including patients, staff and the facility as a whole. We will take responsibility for our actions.

Expertise - We will demonstrate superior judgment, training and skill, at all times, demonstrating professionalism while doing so. We will perform all aspects of our job to the best of our ability, utilizing all resources and tools available.

Approachability - We will be non-judgmental, friendly, and open and willing to listen to everyone; we come into contact with while performing our duties. We are humble and learn from others.

Respect - We will be understanding and sensitive to others’ feelings; caring and responding in a manner that sets them at ease, keeping the situation in perspective without minimizing others’ feelings or reactions. We will listen to others with full attention in a sincere, civil fashion, being careful not to be judgmental of the speaker. We maintain composure when facing conflict and avoid jumping to conclusions and defaming another’s name.

Teamwork - We willingly work together with a common approach, trusting and supporting members of our organization, using our skills and resources, sharing information to achieve a common aim.

PART III: ESSENTIAL FUNCTIONS

Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Following are the essential functions of the job, along with the corresponding performance standards.

Responsibilities

• Working payer denials, documentation requests and appeals in a timely manner to secure payment for services.
• Working various follow up WQs (Work queues) and A/R agings in an effort to secure payment before account goes timely with payer.
• Status claims with payers that have had no activity and remain unpaid via payer portals, phone calls, emails and take appropriate action.
• Identify and report denial trends seen with specific services, end users and Providers so preventative fixes or education can be performed.
• Supporting the projects and initiatives of the Revenue Cycle team. This may include brainstorming meetings, conducting research for payer criteria and preparing documents/written processes.
• Will sign up for payer listservs, newsletters and webinars to stay on top of industry and payer changes.
• Misc related duties as assigned

Revenue Cycle Focus

• To collect on claims/accounts for prompt payment staying within payer timely filing limitations.
• Clean up unpaid arrears via research and troubleshooting of accounts in an effort to collect payment in a timely manner.
• Improve cash flow and days cash on hand.
• Decrease days in A/R.
• Software/Process/Staff training and improvements to insure clean claims, fewer denials and prompt payment/better cash flow for the organization.

PART IV: COMPLIANCE

• Must comply with the Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the position.
• The employee has a duty to report any suspected violations of the law or the standards of conduct to the Human Resource Manager or the Chief Executive Officer.

PART V: PHYSICAL AND MENTAL REQUIREMENTS

General Activity

• In a regular workday, employee may:

Sit 1-2 Hours at a time; up to 5 Hours during the day

Stand 1-8 Hours at a time; up to 1-8 Hours during the day

Walk . 5 Hours at a time; up to 2 Hours during the day

Motion

• Employee is required: (In terms of a regular workday, "Occasionally" equals 1% to 33%, "Frequently" 34% to 66%, "Continuously", greater than 67%.)

Bend/Stoop Frequently Kneel, Duration 30 sec Occasionally

Squat Occasionally Balance Occasionally

Crawl, Distance Not at all Twist Occasionally

Climb, Height Not at all Keyboarding/Moussing Frequently

Reach above shoulder level Occasionally

Physical Demand

Employee’s job requires he/she carry and lift loads from the floor, from 12 inches from the floor, to shoulder height and overhead. Employee’s job requires a pushing/pulling force to move a load (not the weight of the load).

Physical Demand Classification: Carrying/lifting weight and pushing/pulling force:

• Sedentary Occasionally 20 lbs.
• Frequently Negligible
• Constantly Negligible

Sensory Requirements:

• Yes/No Explanation (if Yes)

Speech - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. Yes Must be able to direct groups of employees, give directions, and provide information quickly and thoroughly.

Vision (VDT) - Are there specific vision requirements for the job? Yes Must be able to read procedures, policies, etc., and observe the performance of employees.

Hearing - Ability to receive detailed information through oral communications, and to make fine discriminations in sound; i.e., using a telephone. Yes Must be able to listen to others in order to communicate effectively.

Environmental Factors

• Yes/No Explanation (if Yes)

Working on unprotected heights No

Being around moving machinery No

Exposure to marked changes in temperature and humidity No

Driving automotive equipment No

Wearing personal protective equipment No

Exposure to atmospheric conditions (i.e. fumes, dust, odors, mists, gases, or poor ventilation) No

Exposure to extreme noise or vibration No

Exposure to blood, body fluids and waste No

Exposure to radiation No

Exposure to other hazards (i.e. mechanical, electrical, burns, or explosives) No

Emotional/Psychological Factors

• Yes/No Explanation (if Yes)

Stress: Exposed to stressful situations Yes Works in a fast-paced, complex, rapidly changing environment.

Concentration: Must be able to concentrate on work tasks amidst distractions. Yes Experiences multiple interruptions in work and must be able to refocus on priority tasks quickly.

Must exert self-control. Yes Serves as a role model for others. Actions and words have a direct impact on the employees.

PART VI: JOB RELATIONSHIPS

Supervises

1 No supervisory responsibilities

0 Supervisory responsibility

# Direct Reports:

# Indirect Reports:

Age of Patient Populations Served

0 Neonates: 1-30 days

0 Infant: 30 days - 1 yr

0 Children: 1- 12 yrs

0 Adolescents: 13- 18 yrs

0 Adults: 19- 70 yrs

0 Geriatrics: 70+ yrs

1 All

0 Not applicable

Internal Contacts

1 Patients

1 Providers: (i.e. Physicians, Therapists, Social Workers)

1 Staff: (i.e. clinical and administrative support staff)

1 Volunteers

0 Others:

External Contacts

1 Patients

1 Families/Significant Others

1 Providers

1 Vendors

1 Community and Health Agencies

1 Regulatory agencies

1 Other: Job Applicants