Lifespan
Denials Analyst
Lifespan, Providence, Rhode Island, us, 02912
Summary:
Under general supervision of the Denials Manager, the Denials Analyst is responsible for tracking, maintenance, and communication of evolving payer authorization requirements and ensuring system updates based on payer updates related to authorizations for hospital billing related services. Responsible for actively supporting the execution of strategic initiatives, process redesign, root cause analysis, metric/report development, and special projects as it relates to Denials.To be a part of Lifespan, we ask all employees to share our mission of
Delivering health with care
and successfully practice our values of Compassion, Accountability, Respect, and Excellence as these guide our everyday actions with patients, customers, and one another. You are also responsible for knowing and acting in accordance with the principles of the Lifespan Corporate Compliance Program and Code of Conduct.Responsibilities:
Consistently applies the corporate values of respect, honesty, and fairness in improving the health status of the region through the provision of customer-friendly, geographically accessible, and high-value services.Maintain a current knowledge base related to insurance requirements for prior authorization, medical necessity, and medically unlikely edits.Reviews reports/work queues for denied accounts to correctly designate root cause resolution.Maintain a master list of all services within the hospital setting that require authorization by payer/plan by effective dates.Serve as primary resource on prior authorization requirements.Work with Information Technology Services in the design of authorization and medical necessity work queues.Analyze denial reports and recommend changes to workflow as appropriate with impacted departments.Report metrics/trends on authorization denials to internal/external clients.Maintain an audit trail of changes to authorization requirements to assist with root cause analysis.Reviews, tracks, and submits Lifechart system build changes in the payor/plan management portion of the Lifechart system.Works closely with management to evaluate payer changes that may impact reimbursement.Reviews monthly payer updates to identify any changes as it relates to claims processing and effectively communicates that new information to appropriate Lifespan Departments.Develops and maintains a strong working relationship with hospital departments and referring physician offices.Continually evaluates workflow and identifies opportunities to improve process for full and complete payment for all hospital services rendered.Participates in staff meetings, councils, quality improvement teams, and other such meetings as required.Performs other duties as necessary.BASIC KNOWLEDGE:
Associate degree in accounting, business office practices, computer science, or other related area or equivalent experience.EXPERIENCE:
Two to three years' experience in hospital denials or authorization space. Familiarity with ICD-9/10 CPT-4 coding, knowledge of Medicare and third-party payer regulations and guidelines is required. Proficiency in PC software, especially spreadsheet programs. Experience with a healthcare-based computer system (ex: Epic, Meditech, etc.). Ability to effectively manage multiple demands working under moderate to high degree of pressure. Ability to multi-task and problem solve with strong organizational skills. Ability to adhere to strict timelines to avoid costly denials.INDEPENDENT ACTION:
Incumbent functions independently within the scope of department policies and practices; refers specific problems to Manager only when clarification of departmental policies and procedures may be required.WORK LOCATION/EXPECTATIONS:
After orientation at the corporate facilities, work is performed based on the following options approved by management: Full-time schedule worked in office, full-time schedule worked in a dedicated space in the home, or part-time schedule in office and in a dedicated space within the home. Schedules must be approved in advance by management.SUPERVISORY RESPONSIBILITIES:
None.Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran or marital status. Lifespan is a VEVRAA Federal Contractor.This position is Remote in Providence, RI.Location: Corporate Headquarters USA:RI:ProvidenceWork Type: Full TimeShift: Shift 1Union: Non-Union
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Under general supervision of the Denials Manager, the Denials Analyst is responsible for tracking, maintenance, and communication of evolving payer authorization requirements and ensuring system updates based on payer updates related to authorizations for hospital billing related services. Responsible for actively supporting the execution of strategic initiatives, process redesign, root cause analysis, metric/report development, and special projects as it relates to Denials.To be a part of Lifespan, we ask all employees to share our mission of
Delivering health with care
and successfully practice our values of Compassion, Accountability, Respect, and Excellence as these guide our everyday actions with patients, customers, and one another. You are also responsible for knowing and acting in accordance with the principles of the Lifespan Corporate Compliance Program and Code of Conduct.Responsibilities:
Consistently applies the corporate values of respect, honesty, and fairness in improving the health status of the region through the provision of customer-friendly, geographically accessible, and high-value services.Maintain a current knowledge base related to insurance requirements for prior authorization, medical necessity, and medically unlikely edits.Reviews reports/work queues for denied accounts to correctly designate root cause resolution.Maintain a master list of all services within the hospital setting that require authorization by payer/plan by effective dates.Serve as primary resource on prior authorization requirements.Work with Information Technology Services in the design of authorization and medical necessity work queues.Analyze denial reports and recommend changes to workflow as appropriate with impacted departments.Report metrics/trends on authorization denials to internal/external clients.Maintain an audit trail of changes to authorization requirements to assist with root cause analysis.Reviews, tracks, and submits Lifechart system build changes in the payor/plan management portion of the Lifechart system.Works closely with management to evaluate payer changes that may impact reimbursement.Reviews monthly payer updates to identify any changes as it relates to claims processing and effectively communicates that new information to appropriate Lifespan Departments.Develops and maintains a strong working relationship with hospital departments and referring physician offices.Continually evaluates workflow and identifies opportunities to improve process for full and complete payment for all hospital services rendered.Participates in staff meetings, councils, quality improvement teams, and other such meetings as required.Performs other duties as necessary.BASIC KNOWLEDGE:
Associate degree in accounting, business office practices, computer science, or other related area or equivalent experience.EXPERIENCE:
Two to three years' experience in hospital denials or authorization space. Familiarity with ICD-9/10 CPT-4 coding, knowledge of Medicare and third-party payer regulations and guidelines is required. Proficiency in PC software, especially spreadsheet programs. Experience with a healthcare-based computer system (ex: Epic, Meditech, etc.). Ability to effectively manage multiple demands working under moderate to high degree of pressure. Ability to multi-task and problem solve with strong organizational skills. Ability to adhere to strict timelines to avoid costly denials.INDEPENDENT ACTION:
Incumbent functions independently within the scope of department policies and practices; refers specific problems to Manager only when clarification of departmental policies and procedures may be required.WORK LOCATION/EXPECTATIONS:
After orientation at the corporate facilities, work is performed based on the following options approved by management: Full-time schedule worked in office, full-time schedule worked in a dedicated space in the home, or part-time schedule in office and in a dedicated space within the home. Schedules must be approved in advance by management.SUPERVISORY RESPONSIBILITIES:
None.Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran or marital status. Lifespan is a VEVRAA Federal Contractor.This position is Remote in Providence, RI.Location: Corporate Headquarters USA:RI:ProvidenceWork Type: Full TimeShift: Shift 1Union: Non-Union
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