Denials Management Assistant

Position Summary:

Responsible for providing assistance to the Denials Team in the coordination of CMS and Third-party payer denials/appeals, as well as, performing clerical functions to ensure the efficient operation of the department.

Essential Functions and Responsibilities as Assigned:

• Assists with the team to determine the appropriate hospital setting (inpatient vs. observation) based on medical necessity.

• Maintains current knowledge of hospital billing processes and participates in the resolution of retrospective billing issues including appeals, PACER authorization, third party payer certification, and denied cases.

• Assists in performs retrospective denial management-related activities and functions to ensure that appropriate data are tracked, evaluated, and reported.

• Communicates with A/R, denials, finance/billing, and HIM to render appropriate information needed to appeal/secure reimbursement dollars.

• Assists with monitoring the effectiveness/outcomes of denial management. Provides prompt feedback regarding payor denials to the team.

• Attends meetings and prepares agendas and minutes.

Qualifications:

Required

• High school diploma

• Two years of clerical experience

• One-year experience in a heath care environment utilizing medical terminology or have completed a college level course in medical terminology

Preferred:

• Associate degree in healthcare related field

• Two years of case management or utilization review, billing, or coding experience

• Three years of recent experience doing third party payer certification

• Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross or equivalent through the Military Training network (MTN)

Additional Information

• Schedule: Full-time
• Requisition ID: 26011393
• Daily Work Times: 8am - 4:30pm
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No

About Us

The McLaren system includes 12 hospitals across the state, ambulatory surgery centers, imaging centers, a 730-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 242,000 Michigan lives, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network, and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer center. McLaren has 20,000 full-, part-time and contracted employees and more than 93,000 network providers throughout Michigan.