Summary:

Under general supervision of the Denials Manager the Denials Analyst is responsible for the tracking maintenance communication of evolving payer authorization requirements and ensuring system updates based on payer updates related to authorizations for hospital billing related services. Responsible for actively supporting the execution of strategic initiatives process re-design root cause analysis metric/report development and special projects as it relates to Denials.

To be a part of Lifespan we ask all employees to share our mission of �Delivering health with care� and successfully practice our values of Compassion Accountability Respect and Excellence as these guide our everyday actions with patients customers and one another. You are also responsible for knowing and acting in accordance with the principles of the Lifespan Corporate Compliance Program and Code of Conduct.

To be a part of Lifespan we ask all employees to share our mission of �Delivering health with care� and successfully practice our values of Compassion Accountability Respect and Excellence as these guide our everyday actions with patients customers and one another. You are also responsible for knowing and acting in accordance with the principles of the Lifespan Corporate Compliance Program and Code of Conduct.

 

Responsibilities:

Consistently applies the corporate values of respect honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly geographically accessible and high-value services within the environment of a comprehensive integrated academic health system. Is responsible for knowing and acting in accordance with the principles of the Lifespan Corporate Compliance Program and Code of Conduct.

Maintain a current knowledge base related to insurance requirements for prior authorization medical necessity and medically unlikely edits.

Reviews reports/work queues for denied accounts to correctly designate root cause resolution and other required fields to ensure accurate data collection for system-wide reporting needs.

Maintain a master list of all services within the hospital setting that require authorization by payer/plan by effective dates

Serve as primary resource on prior authorization requirements

Work with Information Technology Services in the design of authorization and medical necessity work queues by submitting IT tickets for build requirements as it relates to authorizations and medical necessity and its system components for the various departments in the organization

Analyze denial reports and recommend changes to workflow as appropriate with impacted departments on any deficiencies in workflow or system build

Report metrics/trends on authorization denials to internal/external clients

Maintain an audit trail of changes to authorization requirements to assist with root cause analysis and support cause for appeals

Reviews tracks and submits Lifechart system build changes in the payor/plan management portion of the Lifechart system as it relates to authorization requirements

Works closely with management to evaluate payer changes or other items that may impact reimbursement affected by prior authorization medical necessity and MUE�s etc.

Reviews monthly payer updates to identify any changes as it relates to claims processing authorization requirements medical necessity etc. and effectively communicates that new information to appropriate Lifespan Departments and personnel.

Develops and maintains a strong working relationship with hospital departments and referring physician offices to collaborate in obtaining information needed for successful appeal/reversal of an authorization denial.

Continually evaluates workflow and identifies opportunities to improve process for full and complete payment for all hospital services rendered to patients

Participates in staff meetings councils quality improvement teams and other such meetings and committees as required.

Develops and maintains working relationship with Lifespan affiliate departments as needed to ensure fully data exchange.

Performs other duties as necessary.

 

Other information:

BASIC KNOWLEDGE:

Associate degree in accounting business office practices computer science or other related area or equivalent experience.

EXPERIENCE:

Two to three years� experience in hospital denials or authorization space.

Should be familiar with ICD-9/10 CPT-4 coding.

Knowledge of Medicare and third-party payer regulations and guidelines required

Proficiency in PC software especially spreadsheet programs

Experience with a healthcare-based computer system (ex: Epic Meditech etc.)

Ability to effectively manage multiple demands working under moderate to high degree of pressure

Ability to multi-task and problem solve with strong organizational skills

Ability to adhere to strict timelines to avoid costly denials

INDEPENDENT ACTION:

Incumbent functions independently within scope of department policies and practices; refers specific problems to Manager only when clarification of departmental policies and procedures may be required.

WORK LOCATION/EXPECTATIONS:

After orientation at the corporate facilities work is performed based on the following options approved by management and with adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure.

Full time schedule worked in office.

Full time schedule worked in a dedicated space in the home.

Part time schedule in office and in a dedicated space within the home.

Schedules must be approved in advance by management who will allow for flexibility that does not interfere with the ability to accomplish all job functions within the said schedule. Staff are required to participate in scheduled meetings and be available to management throughout their scheduled hours. Staff must be signed into Microsoft Teams during their entire shift and communication with Supervisor as directed.

 

SUPERVISORY RESPONSIBILITIES:

None.

 

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.

 

Location: Corporate Headquarters USA:RI:Providence

 

Work Type: Full Time

 

Shift: Shift 1

 

Union: Non-Union

Apply