Denials Specialist

The Denials Specialist supports all denials management functions for Patient Financial Services. Maintains and updates denials management data, and conducts analyses for trending and reporting. Responsible for conducting root-cause analysis of denials, interacting and meeting with departments throughout the hospital requiring assistance in addressing denials. Responsible for working denials that are escalated for review and resolution. Works with PFS or other departments to develop and maintain all denials management training and guidelines. Partners with management and staff in PFS, Ambulatory Services, Case Management, Patient Access and HIM.

Additional Information
Department Name:Patient Financial Services
Job Status:Full time, 40 hours per weeek.
Shift: Day, Shift can vary, but can be within hours of 6am to 5pm. Hybrid.

Duties & Responsibilities

• Conducts root-cause analysis of denials to determine where improvements within PFS or other departments may be necessary.
• Conducts analysis and develops reports of denial patterns by payors, denial types, or departments.
• Works with systems to determine payment problems and billing and collection problems. Assists in communicating those problems to various components within PFS and other departments.
• Collaborates with and provides support to PFS staff and management in appeals including, but not limited to, follow-up with departments where letters of medical necessity are required or retro-authorizations are needed, staff escalation of appeals requiring action or drafting letters to payors, follow-up with payors on denials, etc.
• Researches contract terms/interpretation and compiles necessary supporting documentation for appeals.
• Follows-up timely to insure appeals are met within the allowed time periods as dictated by the various payors.
• Responsible for supporting teams in denials education and training. Supports staff in most effective practices for denial management.
• Responsible for developing documentation and guidelines in denials management - supported by PFS management.
• Supports all users with denials management software.
• Updates and maintains denials trending reports.
• Provides information and supports monthly meetings.

Minimum Qualifications

• Degrees

  • High School diploma or GED
• Experience
  • Minimum Experience Required:Three (3) years of experience in a healthcare or related field (front-line clinic, billing office and/or admissions department) with exposure to billing and denials management.
• Equivalency
  • Additional education may substitute for additional experience above required level.

Salary Information
Pay is dependent on applicant's relevant experience.

Hourly Range: $22.20 to $33.30

Benefits Information
Here, you matter. As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid time off, medical/dental/vision insurance, company provided life and disability insurance, paid parental leave, 403b employer match (retirement savings), a robust wellness program, and access to professional development tools, including an education benefit to help you advance your career.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.

EEO Statement
It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information. The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information.