Are you an internal caregiver, student, or contingent worker/agency worker at UMass Memorial Health? CLICK HERE to apply through your Workday account.

Exemption Status:

Non-Exempt

Schedule Details:

Monday through Friday

Scheduled Hours:

8-4

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

99940 - 5404 Denials

Union:

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

I. Major Responsibilities: (List in order of time allocated)

1. Completes appropriate actions needed for an effective appeal including conducting authorization research, rebilling, and balance write off or transfer to next responsible party.  Escalates issues as appropriate.
2. Corresponds with third party payers, hospital departments, and patients to obtain information required for denial resolution following payer timelines. Releases information following Federal, State and Hospital guidelines.  
3. Uses assigned work queues and prioritization standards and guidelines to perform denial resolution follow up.   
4. Uses reference material to troubleshoot payer issues and increase understanding of denial resolution techniques. Reference payer websites as needed.
5. Analyzes and researches the denial reasons for each assigned denial code.
6. Determines and executes the best approach for denial resolution utilizing all available resources.  
7. Follows payers established procedures and timelines to submit appeals utilizing payers preferred method, i.e., electronically or via paper.
8. Documents all actions taken during the denial resolution process clearly including actions taken, next steps, payer processing timelines, etc. 
9. Adjusts account balances using correct transaction code adhering to established departmental policies.  
10. Follows established protocols to ensure all documents are retained appropriately
11. Meets established quality and productivity standards.
12. Facilitates and promotes the sharing of knowledge and content throughout departments.
13. Follows all established Hospital Billing Revenue Cycle Management departmental and compliance policies and procedures.
14. Participates in cross training of billing resources.
15. Demonstrates excellent attendance and actively participates in a variety of meetings and training sessions as required.
16. Maintains and fosters an organized, clean, and safe work environment.
17. Contributes to the development and application of process improvements. Practices cost containment and fiscal responsibility through the efficient use of supplies, equipment, time, etc.

Standard Staffing Level Responsibilities:

1. Complies with established departmental policies, procedures and objectives.
2. Attends variety of meetings, conferences, seminars as required or directed.
3. Demonstrates use of Quality Improvement in daily operations.
4. Complies with all health and safety regulations and requirements.
5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
6. Maintains, regular, reliable, and predictable attendance.
7. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

II. Position Qualifications:

License/Certification/Education:

Required:
1. High School diploma 

Experience/Skills:
Required:
1. Previous Revenue Cycle knowledge in one of the following areas including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party Reimbursement.
2. Ability to perform