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DENIALS MANAGEMENT TECH
The Denials Management Tech essentially works to coordinate the payor denials/appeal communication as part of the denial management process. Denials management tech is responsible for tracking communication from Covenant�s CRM Department, CBO Department, Request for Information Department, various insurance payors, and various payor audits. Coordinate all denials and appeals correspondence. Responsible for maintaining tracking and communication through the EPIC electronic medical record application, requesting information from ROI, and preparation of support information used in the appeal process. Works closely with Denials Management Specialists, Utilization Management, Billing, and Insurance Payors.
Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation.
� Review denied accounts placed on EPIC work queue from Utilization Management or Central Billing Office. Review denial letters and account information to determine denial issue and course of action (with DMG Specialist assistance).
� Prepare Appeal Packets including Printing UM information, gathering denials letters, requesting claims from CBO, requesting chart from ROI, verify with physician advisory EHR, open denial record in EPIC, identify and document appeal due dates.
� Review Payor Additional Documentation Requests (ADR). Scan letters add notes to accounts, send to ROI to request records.
� Review Payor appeal responses. Scan letters, add result notes to accounts, email to appropriate group.
� Review denials EPIC work queue to update appeal status
� Follow up with insurance payors for responses on appealed accounts.
Qualifications:
Preferred Qualifications
� Minimum one-year denials management or hospital billing experience
� Should have strong working knowledge of hospital / office operations in the organization
� Experience navigating EPIC electronic medical record
� Strong computing skills including a working knowledge of Word, and Excel, web browsing, and email applications and/or a willingness to learn
� Excellent written and verbal communication skills with demonstrated capabilities in follow-up activities
� Must demonstrate a positive and enthusiastic attitude in all interactions
� Must be a team player with the ability to work independently as well as in small or large teams
� Demonstrates the ability to resolve problems timely and effectively
� Must be approachable and can deal positively with employees at all levels of the organization
� Protects and maintains the confidential nature of information
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