North Arkansas Regional Medical Center

Denials Management Coordinator

US-AR-Harrison
Job ID
2017-2419
Category
Business Office
Shift
Days
NARMC
Type
Full-Time 80

Overview

Ensure maximization of NARMC’s contracted-payer receivables, including both private sector and government payers. It is essential Denials Management Coordinator familiarizes themselves both with the terms of our commercial payer contracts, Medicare DRG and APC fee schedules, Medicaid’s rate structures/per diems as well as the Denials Management (“calculation”) module of the hospital’s billing systems.

Responsibilities

Performance Expectations:

  • From a review of systems reports that list accounts whose receipts vary from that calculated by the system, as well as by review of the various explanations of benefits documents or remittance advices received by the hospital, this staff member must ascertain both the amount of the variance and the reason for the variance.       This information must be logged on a spreadsheet for purposes of tracking and trending, and reported periodically or as outlined by directives of Administrative and oversight Director/Manager(s). 
  • Maintain integrity of Denials Management system by updating contract terms prior to initiation of contract renewal. Testing of contract terms in "test" environment prior to contract roll-out. 
  • On-going audits of each contracted payer. Sample testing of each payer must be performed on an ongoing basis, with results reported to management monthly (or on an as-needed basis). Immediate reporting to Business Office Director of issues these audits reveal which may have an impending impact on receivables or allowances (adjustments). 

 

Other Course(s) of Expected Action to be taken by Staff Member:

 

  • If found that the variance is due to an error by the payer and therefore not in keeping with the terms of our established contract, this staff member must work with the payer to procure the correct payment. This will fundamentally entail an appeal to the payer, accompanied by letter or note of details on how the payment is in breach of the existing contract, and our expected remediation/dollar total. 
  • If found that the variation is due to miscalculation within Denials Management's language coding, corrected coding must be implemented, with resultant testing taking place to ensure that future reimbursements (as well as ensuring resultant adjustments/allowances are accurate). 
  • If found that the variation is related to issues involving other departments (such as incorrect procedural or diagnosis coding; lacking of pre-certification; non-payable procedures, et al) this staff member must work with the designated departmental personnel to make corrections where possible (while maintaining the highest level of ethics and compliance), alerting department management of non-paid or underpaid procedures, et al, in order to ensure maximized payment for both appealed and future procedures (or any services rendered, such as an room & bed charges). 
  • Staff member is responsible for statistical tabulation and reporting of all aspects of these related tasks, including, but not limited to: 
  • Variance findings 
  • Appeals: Submitted, approved, denied; 
  • Departmental-related reimbursement statistics, 
  • Other statistical reporting and archiving- as directed or germane to the positional endeavor.

 

 

 

Qualifications

Education:

 High School diploma or equivalent with emphasis in business and office occupations.

Experience:

 1 - 3 years' experience in medical billing.

Degrees, Licensure, and/or Certification:

 

Knowledge, Skills, and Abilities:

Ability to read, write, speak and understand English.  Previous office/clerical skills, accurate typing skills and computer knowledge.

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