Qureos Mentor

DCH HEALTH SYSTEM

<div>Overview:
<div>
The Denials and Insurance Follow-Up Specialist is responsible for managing denied claims, following up with insurance payers, and ensuring accurate reimbursement for hospital services. This role is critical to optimizing revenue recovery by investigating, correcting, and resubmitting denied claims while working closely with the Revenue Cycle Management (RCM) team to identify and address patterns in denials. The ideal candidate will have strong analytical skills and experience in medical billing and insurance follow-up, with a focus on reducing accounts receivable days and improving cash flow.</div>
Responsibilities:<p></p><div><ul><li><b><br>
Denial Management:</b></li></ul><ul><li>
Review and analyze denied claims to determine the cause of denial, coordinating with coding, billing, and clinical staff as needed to gather additional information or correct claim errors.</li><li>
Prepare and submit appeal documentation for denied claims, following up with payers to ensure resolution within timely filing limits.</li><li>
Track, document, and report denial reasons, resolution actions, and outcomes, identifying patterns and trends that require additional training or process improvements.</li><li><b>
Insurance Follow-Up:</b></li></ul><ul><li>
Conduct timely follow-up on unpaid claims with insurance companies, ensuring that all accounts are resolved or escalated within the hospital&rsquo;s standard timeframes.</li><li>
Verify insurance eligibility and benefits as needed to validate patient coverage and support claims correction or resubmission.</li><li>
Communicate effectively with insurance representatives to resolve outstanding issues, confirm payment status, and clarify discrepancies in payments or coverage.</li><li><b>
Account Reconciliation and Resolution:</b></li></ul><ul><li>
Reconcile accounts to ensure payments align with expected reimbursement, identifying and addressing underpayments, overpayments, or unapplied funds.</li><li>
Work closely with the RCM team to adjust accounts, apply payments accurately, and resolve balances on patient accounts after denial or underpayment resolution.</li><li><b>
Reporting and Analysis:</b></li></ul><ul><li>
Generate and analyze regular reports on denial rates, follow-up activities, and recovery outcomes to provide insights into common denial reasons and support improvement strategies.</li><li>
Collaborate with management to develop and implement best practices for denial prevention, appeal success rates, and insurance follow-up efficiency.</li></ul></div>
Qualifications:
<h1 class="jobSectionHeader"><b>Qualifications:</b></h1><ul><li><b>
Education:</b></li><li>
High School Diploma or General Education Degree (GED) or 5 years&rsquo; experience in healthcare setting required.</li></ul><ul><li><b>
Experience:</b></li><li><ul><li>
Minimum three (3) years&rsquo; experience in medical billing.</li><li>
Prior experience do physician/provider professional fee billing is preferred.
</li><li>Familiarity with payer requirements, denial codes, and appeals processes for a range of insurance plans, including Medicare, Medicaid, and commercial payers.</li></ul></li><li><b>
Skills and Abilities:</b></li><li><ul><li>
Strong knowledge of healthcare claims processing, insurance reimbursement, and medical terminology.</li><li>
Proficiency with electronic health record (EHR) and revenue cycle management (RCM) software.</li><li>
Excellent analytical skills with the ability to identify root causes of denials and recommend corrective actions.</li><li>
Detail-oriented with excellent organizational and time management skills, ensuring timely follow-up and adherence to deadlines.</li><li>
Strong verbal and written communication skills, able to effectively interact with insurance</li><li>
Strong communication and interpersonal skills to coordinate effectively with team members and external partners.</li><li>
Able to analyze problems and strategize for better solutions</li><li>
Ability to read and comprehend instructions, short correspondence and memos.
 </li><li>Ability to effectively present information in one on one and small group meetings to clients and staff.
</li><li>Able to Multi-tasking, prioritization, time management and critical thinking skills required.
</li><li>Proficient computer skills, Microsoft Office Suites.
</li><li>Must be able to use personal transportation to provide courier services for the office.
</li></ul></li></ul><div><b>DCH Standards:</b></div><ul><li>
Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.</li><li>
Performs compliance requirements as outlined in the Employee Handbook</li><li>
Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.</li></ul><ul><li>
Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.</li><li>
Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.</li><li>
Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.</li></ul><ul><li>
Requires use of electronic mail, time and attendance software, learning management software and intranet.</li><li>
Must adhere to all DCH Health System policies and procedures.</li><li>
All other duties as assigned.</li></ul><div></div><div><b><br>
WORKING CONDITIONS</b></div><p></p><p><br>
Physical presence onsite is essential with possibility of hybrid work schedule. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation.</p><div>
Valid driver&rsquo;s license and automobile liability insurance. Very good interpersonal communication and customer service skills required.<br>
</div><div></div><div><b>Physical: </b>Medium work &ndash; Exerting 20 &ndash; 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to more objects. Physical Demand requirements are in excess of those for Light Work. Good manual and finger dexterity. Ability to tolerate prolonged periods of sitting. Some light driving required.
</div><div><b>Psychological: </b>Contact with Others, Deal with external customers/clients, sometimes dealing with unpleasant people, occasionally coordinating letters/memos, working with work groups or as a Team constantly/consistently.</div></div>

Denials Specialist II

<div>Overview:
<div>
The Security Officer assigned to the Behavioral Health Unit ensures the safety and security of patients, staff, visitors, and the premises within the hospital's behavioral health department. This role is critical in managing challenging behavioral situations, de-escalating potential conflicts, and responding swiftly to emergencies while maintaining a calm, supportive presence. Security Officers must remain alert to potential safety risks while respecting the sensitive nature of the unit, ensuring that all protocols are followed to protect both patients and hospital personnel.</div>
Responsibilities:
<div><b>
Safety and Security:</b></div><ul><li>
Monitor and secure the premises to prevent unauthorized access or disturbances.</li><li>
Conduct regular patrols of the unit, ensuring all areas are safe and free of hazards.</li><li>
Respond promptly to alarms, emergencies, or incidents within the unit.</li><li>
Assist in the prevention and de-escalation of potentially volatile situations.</li><li>
Maintain a calm and respectful presence, helping to create a secure and therapeutic environment.</li><li>
Assist clinical staff in non-physical interventions to manage patient behavior.</li><li>
Support the enforcement of unit policies while treating patients with dignity and respect.</li><li>
Observe and report any unusual patient behavior or security concerns.</li><li>
Operate and monitor surveillance systems as necessary.</li><li>
Provide detailed reports of incidents, safety checks, and other relevant activities utilizing hospital reporting and any other required
</li><li>Adhere to hospital policies, procedures, and safety regulations.</li><li>
Maintain confidentiality in accordance with HIPAA and other legal standards.</li><li>
Complete initial and ongoing training in behavioral health, de-escalation techniques, and crisis management.</li><li>
Attend and participate in staff meetings and education.</li></ul><div><b>
Crisis Intervention:</b></div><ul><li>
Participate in emergency response efforts, including various codes and other safety-related protocols.</li><li>
Use non-violent crisis intervention techniques to manage challenging situations safely.</li><li>
Collaborate with the healthcare team to ensure appropriate responses to patient needs.</li></ul><div><b>
Certifications</b>:</div><ul><li>
CPR and First Aid Certification.</li><li>
State-mandated security training or licensing.</li></ul><div><b>
DCH Standards:</b></div><ul><li>
Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.</li><li>
Performs compliance requirements as outlined in the Employee Handbook</li><li>
Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.</li></ul><ul><li>
Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.</li><li>
Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.</li><li>
Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.</li></ul><ul><li>
Requires use of electronic mail, time and attendance software, learning management software and intranet.</li><li>
Must adhere to all DCH Health System policies and procedures.</li><li>
All other duties as assigned.</li></ul>
Qualifications:
<div>
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</div><div>
This position plays a critical role in ensuring a safe and supportive atmosphere for both patients and staff. A compassionate approach paired with vigilance and professionalism is essential.</div><div>
Ability to communicate with individuals on all levels. Must be self-directed, Must have sound judgement, excellent analytical and problem-solving skills and not be afraid of rolling up the sleeves to deliver practical solutions. Must have excellent written and verbal communication skills.</div><div><b><br>
</b></div><div><b>Education and/or Experience</b>: High school diploma or equivalent required. Experience in security, law enforcement, or behavioral health preferred. Certification in crisis intervention or de-escalation techniques (e.g. CPI, Healthy Interventions, etc). Strong communication, observational, and conflict-resolution skills. Ability to remain calm and professional in high-stress situations.</div><div></div><div><b><br>
WORKING CONDITIONS</b></div><div><br>
</div><div>The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</div><div></div><div><br>
Walking, standing, pushing, stooping, bending, stretching, and lifting heavy loads and potential physical intervention. Collaboration with multidisciplinary teams in a fast-paced environment. Required working evenings, weekends, holidays, and rotating shifts</div><div></div><div><br>
Physical presence onsite is essential. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation.</div></div>

Security Officer for Behavioral Health (Part-time-Days)

<div>Overview:
<div>
Responsible for managing and performing efficient and effective Accounts Receivable functions for DCH Regional Medical Center, Northport Medical Center, Fayette Medical Center, DCH Home Health and Home Medical Equipment. Responsible for accurately and timely reviewing, collection of all assigned billed insurance claims. Required to maintain individual and departmental goals for discharged and final billed accounts/claims for AR Aging, AR Days, Cash Collections, etc.</div>
Responsibilities:
<ul><li>Reviews and follows-up for claims processing/collection on all assigned billed insurance claims on a daily basis using Meditech, Optum, payer websites, and other software programs utilized in the Patient Accounts Department.</li><li>
Ability to research and work assigned claims in a billed and unpaid status.</li><li>
Accountable for productivity to meet individual and departmental goals. AR Aging AR Days, Cash Collections, etc)</li><li>
Responds to and works with other DCH departments (Patient Access, Case Management, Medical Records, etc.)
</li><li>Maintain professionalism and customer service on all interactions.</li><li>
Makes recommendations to implement improved processes.</li></ul><p><b>
DCH Standards:
</b></p><ul><li>Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.</li><li>
Performs compliance requirements as outlined in the Employee Handbook</li><li>
Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
</li><li>Requires use of electronic mail, time and attendance software, learning management software and intranet.</li><li>
Must adhere to all DCH Health System policies and procedures.</li><li>
All other duties as assigned.</li></ul>
Qualifications:
<div>
High School education or equivalent is required. One year or more of related experience in a Healthcare Business Office preferred. Knowledge of insurance types related to claims billing and follow-up such as governmental, HMO, PPO, Commercial, etc. Knowledge of federal, state, hospital, and departmental rules and regulations for compliant Healthcare claims filing and reimbursement preferred.</div><div>
Proficient in personal computer skills. Very good interpersonal/communication skills, customer service skills and history of good attendance required</div><div>
Must be able to read, write legibly, speak, and comprehend English.</div><div><b><br>
</b></div><div><b>WORKING CONDITIONS</b></div><div></div><div><b><br>
WORK CONTEXT</b></div><div></div><div><br>
Interpersonal relationships:
</div><div>Job requires daily phone and/or face to face communication with co-workers and/or outside sources.</div><div></div><div><br>
Physical work conditions:</div><div>
Working indoors in a cubical area, sitting 80% of the time, standing 5%, kneeling 2.5%, squatting/crouching 2.5%, stooping 5%, and walking 5%. Activities include lifting of 35 lbs. maximum which would be a two (2) person lift, frequent lifting and/or carrying 20 lbs. Ability to push or pull over carpet floors, concrete ramps and on varied surfaces, a four wheel cart with 50 lb. of paperwork.</div><div>
Filing ledgers or finding ledgers requires reaching, pushing, pulling, and extending the hands and arms in any direction. Stooping and bending the body forward by bending the spine at the waist. To reach lower areas requires kneeling by bending the legs at the knee or crouching by bending the body downward and/or forward by bending the legs and spine. This is 50% of daily work.</div><div>
Organizing charts requires handling of papers by holding, grasping and turning, with picking up and pinching as finger movements. This is a repetitious procedure that is constantly being done.</div><div>
Communication through talking, expressing or exchanging ideas by means of the spoken word. Hearing; perceiving the nature of sounds of the ear in order to communicate. Seeing; use of vision to determine characteristics of objects, depth perception, color vision with the ability to distinguish color, coding ledgers, near/far activity of 100% daily.</div><div>
Mental Capability to maintain patient confidentiality 100% of the time.
</div><div>Physical presence onsite is essential. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation.</div><div></div><div><br>
Structural job characteristics: Job requires 16-40 hours of repetitive work on desktop, per week.</div><div><br>
</div><div><b>PHYSICAL FACTORS</b></div><ul><li>
The Americans with Disabilities Act (ADA) requires the job description to document physical factors, including ability, activities, and requirements.
</li></ul><ul><li>Ability: Must be able to sit for extended periods of time and lift boxes up to 20 pounds.
</li><li>Activities: Job requires ability to communicate through spoken word, ability to use fingers for data entry</li><li>
Requirements: Please indicate the physical requirements of the job as one of the following:<ul><li>
Light work. 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. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.</li></ul></li><li>
Must be able to perform the duties with or without reasonable accommodation.</li><li>
Hearing and vision must be normal or corrected to within normal range.
</li><li>Physical presence onsite is essential.
</li></ul><div><b>OTHER JOB FACTORS</b></div><ul><li>
Job requires being reliable, responsible, and dependable, and fulfilling obligations</li><li>
Job requires a willingness to take on responsibilities and challenges</li><li>
Job requires being open to change (positive or negative)</li><li>
Job requires analyzing information and using logic to address work-related issues and problems</li><li>
Job requires being careful about detail and thorough in completing work tasks</li><li>
The ability to remember information such as procedures.</li><li>
The ability to understand information presented through spoken word or presented in writing.</li><li>
The ability to communicate in speaking so others will understand.</li><li>
The ability to tell when something is wrong. It does not involve solving the problem, only recognizing the problem.</li><li>
The ability to concentrate on a task over a period of time without being distracted.</li><li>
The ability to shift back and forth between two or more activities or sources of information.</li><li>
The ability to make fast, simple, repeated movements of the fingers, hands, and wrists</li><li>
The ability to focus on a single source of sound in the presence of other distracting sounds</li><li>
The ability to speak clearly so others can understand you.</li><li>
The ability to identify and understand the speech of another person</li><li>
Must be results oriented,</li><li>
Must be able to work independently with little or no supervision.</li><li>
Must be able to work well with others.</li></ul></div>

Insurance Specialist

<div>Overview:
<div>
Provides routine therapeutic services under the supervision of therapist or therapist assistants</div>
Responsibilities:<br>
<div></div><ul><li>
Provides routine services to patients, as outlined in department scope of service, working under the direct supervision of licensed therapist or therapist assistant and provides accurate written and/or verbal objective feedback and documentation of observations, as necessary, related to the patient&rsquo;s response to such activities, utilizing correct forms or system tools.</li><li>
Assists in training of new employees and assists with volunteers..
</li><li>Observes patients during activity and reports patient responses orally or in writing to therapist or therapist assistant.</li><li>
Maintains a safe and clean work environment for the patients.</li><li>
Attends in services and departmental or hospital meetings.</li><li>
Assists in department quality control (equipment checks, temp logs, cleaning checklists etc, and upkeep.)
</li><li>Performs clerical duties as needed.
</li><li>Prepares equipment, rooms, and patients for therapy treatment.
</li><li>Completes competency as outlined.
</li><li>Transports patients as needed/required</li><li>
Performs transportation of supplies from nursing areas for patient treatments and restock supplies in the department.</li><li>
Checks with other staff to offer assistance throughout the day.</li></ul><p></p><div><b><br>
DCH Standards:</b></div><ul><li>
Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.</li><li>
Performs compliance requirements as outlined in the Employee Handbook</li><li>
Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.</li></ul><ul><li>
Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.</li><li>
Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.</li><li>
Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.</li></ul><ul><li>
Requires use of electronic mail, time and attendance software, learning management software and intranet.</li><li>
Must adhere to all DCH Health System policies and procedures.</li><li>
All other duties as assigned.</li></ul>
Qualifications:
<div>
High School graduate or equivalent. Must be able to read, write legibly, speak and comprehend English</div><div><b><br>
</b></div><div><b>WORKING CONDITIONS:</b></div><div></div><div><b><br>
WORK CONTEXT</b></div><ul><li>
Must be able to enter and/or patient or treatment data into computers</li><li>
Must be able to collaborate with others to provide treatment</li><li>
Must have normal vision and hearing or correctable to normal</li><li>
Must be careful about detail and thorough in completing work tasks.</li><li>
Must be reliable, responsible, dependable, and fulfilling obligations.</li><li>
Must be pleasant with others on the job and display good nature, cooperative attitude.</li><li>
Must be able to tolerate prolonged periods of sitting and/or standing</li><li>
Must be able to exert almost continual physical effort such as pushing, pulling, bending, climbing, lifting, and walking.</li><li>
Exposure to human bodily fluids, disease, infection and hazardous materials may occur. Common protective or safety equipment may be required in job task.</li></ul><div><br>
</div><div><b>PHYSICAL FACTORS</b></div><ul><li>
Physical activities include: Talking, hearing, bending, twisting, walking, running, kneeling, crouching, stooping, crawling, climbing, balancing, reaching, pushing, pulling, lifting, grasping, repetitive motion, standing, and/or using hands to handle, control, or feel objects, tools or controls.</li><li>
Requirements:
</li><li><b>PT/OT</b><ul><li>
Heavy work. Exerting up to 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.</li><li>
Must be able to perform the duties with or without reasonable accommodation.</li><li>
Hearing and vision must be normal or corrected to within normal range.
</li><li>Physical presence onsite is essential.</li></ul></li></ul></div>

RMC Acute Rehab Aide

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DCH HEALTH SYSTEM

About Company

Denials Specialist II

Security Officer for Behavioral Health (Part-time-Days)

Insurance Specialist

RMC Acute Rehab Aide