Job Description

Job Summary:

The Denial Specialist’s role is vital to ensure that hospital-denied accounts are thoroughly reviewed for any opportunity to correct, refile and or appeal claims for re-processing and reimbursement. The role also includes review and rework of all types of PFS denials. Good writing and analytical skills are a must.

Essential Functions:

1. Review and manage daily PFS denials, ensuring timely completion.

2. Monitor A/R days to meet management expectations.

3. Identify denial trends, report to the supervisor, and suggest solutions.

4. Handle insurance calls, aiding issue resolution and data retrieval.

5. Foster communication with payors and the team for claim resolution.

6. Validate coding accuracy using CAC tools.

7. Address third-party denials per payer guidelines and file appeals.

8. Write off denials as needed after a thorough review.

9. Complete assigned projects and research and prepare Denial reports for the System Director of Revenue Cycle.

10. Foster professional growth through participation in in-service meetings and educational programs.

11. Ensure strict adherence to confidentiality policies and job-related procedures.

12. Refer complex or sensitive issues promptly to higher management for resolution.

13. Report any irregularities in cash or denial posting processes to the Billing Director.

14. Demonstrate adaptability by accepting and learning new tasks as needed.

15. Support departmental efficiency by assisting colleagues with daily tasks and special projects.

Essential Requirements: Associates Degree required, Bachelors in Healthcare Administration or Finance preferred. Certified Revenue Cycle Representative preferred. Proficiency with Meditech Expanse & Inovalon Clearing House preffered.

About North Country Healthcare (NCH):

North Country Healthcare is a non-profit affiliation of four medical facilities, Androscoggin Valley Hospital, North Country Home Health & Hospice Agency, Upper Connecticut Valley Hospital, and Weeks Medical Center, located in the White Mountains Region of New Hampshire. NCH includes numerous physicians and medical providers at multiple locations. This leading comprehensive healthcare network which employs hundreds of highly-trained individuals delivers integrated patient care through three community hospitals, specialty clinics, and home health and hospice services. NCH remains committed to the health and well-being of the communities we serve.

North Country Healthcare is an equal-opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

If you require a reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to the Human Resources department at the affiliate to which you are applying.

Application Instructions

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