Denials Administrative Specialist

Role Overview

• Review and compile required denials documentation and submit in a timely manner to ensure payment.
• Track and document tasks in Midas to assist Nurse Denials Specialist in preparing and following up on cases.
• Assist in preparing documentation for appeal letters.
• Track and monitor concurrent and retrospective cases on denials spreadsheets.
• Assist in auditing for concurrent reviews, admission status, coding, DRG, and outpatient denials management.
• Assist in gathering data for performance of retrospective denials.
• Gather data and documentation to assist the Nurse Denials Specialist and the Physician Advisor in review of clinical denials.
• Request necessary documentation from physician's offices for denials cases.
• Assist with paperwork and follow up of self-denials cases, Code 44s, and Noridian appeal cases.
• Track and monitor audits of clinical information from payers, governmental agencies, etc.
• Provide outreach and assistance to other support staff within the department when absent or in need of additional support of their work.
• Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.
• Stays current and complies with state and federal regulations/statutes and company policies that impact the employee's area of responsibility.
• If required for the position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.

Requirements

• High School Diploma or GED
• Required
• Associate's Degree or some college education
• Preferred
• Previous experience in denials management or relatable experience
• Preferred

Benefits

• Telecommute
• Health insurance
• Paid time off