How you move is why we’re here. ®
Now more than ever.

Get back to what you need and love to do.
The possibilities are endless...
 
Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success.
 
If this describes you then let’s talk!
 
HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.

Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.

Emp Status

Regular Full time

Work Shift

Day (United States of America)

Compensation Range

The base pay scale for this position is $25.83 - $39.43. In addition, this position will be eligible for additional benefits consistent with the role. The salary of the finalist selected for this role will be determined based on various factors, including but not limited to: scope of role, level of experience, education, accomplishments, internal equity, budget, and subject to Fair Market Value evaluation. The hiring range listed is a good faith determination of potential compensation at the time of this job advertisement and may be modified in the future.

What you will be doing

JOB DESCRIPTION

Denials Specialist

The Denials Specialist will have responsibility for the management, reporting, recovery, and prevention of clinical and technical denials received on Hospital services.

JOB RESPONSIBILITIES: The specific responsibilities include, but are not limited to:

Reviews claims in which a denial has been received from the payerIdentifies the root cause of the denial and addresses the denial issue with the appropriate department (i.e., Billing, CDM, Clinical Documentation, Coding, etc.)Utilizes available resources to effectively research claims and complete steps to submit information necessary to process or appeal claimsIndependently manages assigned workProduces reports on denial inventory as requestedCommunicates trends in the claim denial populations to the leadership teamInvestigates and ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claimsCompletes and requests adjustments to a claim, as appropriateOrganizes work/ resources to accomplish objectives and meet deadlinesDemonstrates critical thinkingDemonstrates problem-solving skills related to denial analysisManages multiple responsibilities with ease and completes tasks as assignedDemonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively to obtain necessary information to address denial management issuesParticipates in all educational activities, and demonstrates personal responsibility for job performanceAssists in the development of training materialUses supplies and equipment effectively and efficientlyConsistently demonstrates a positive and professional attitude at workMeets quality and productivity requirements to ensure excellent service is provided to customersMaintains compliance with established corporate and departmental policies and proceduresMaintains stable performance under pressure and handles stress in ways to maintain relationships with patients, customers, and co-workersMaintain satisfactory attendance and punctuality record as set forth by HSS policiesResponsible for the other relevant work functions, as requested

EXPERIENCE AND QUALIFICATIONS:

Bachelor’s DegreeMinimum of 2-3 years business office experience in a healthcare environmentEpic Certification preferredExpert level Excel experienceStrong working knowledge of Microsoft Office SuiteAbility to multi-task and switch easily between assignmentsExcellent phone etiquette and internal/external customer services skillsPayment variance or denials management experience preferredDemonstrates knowledge of insurance regulations and policies, payment policies/guidelines and the ability to communicate and work with payers to get claims resolved and paid accuratelyDemonstrate in-depth knowledge and experience in the following technology solutions: patient accounting, optical imaging and scanning, patient systems and internet- based insurance websitesExceptional interpersonal and influencing skills; success at cultivating strong relationships with internal stakeholders and creating partnerships throughout the organization. Experience working with executive and medical leadership, especially physicians and their offices.Resolves issues through innovative problem solving and solution development; capable of gaining commitment to project goals.Stays current on healthcare industry trends and reform; can identify potential impacts and /or problems that may arise during conversion and translate them into remedial action plans.Outstanding communication skills: succinct and easy to understand, a good listener, skilled at influencing a variety of people. Capable of developing and implementing educational programs for a diverse audience.Unquestionable personal integrity. Exudes credibility and professionalism. Very likeable. Quickly builds confidence on others. Team player and understands his/her role in relationship to others.A highly committed individual, with the necessary drive and stamina to successfully oversee the denials management process.

 

YEARS OF EXPERIENCE REQUIRED
Experience in Healthcare and Revenue Cycle. Established knowledge of healthcare and health insurance and familiarity with medical terminology. 5

YEARS OF EXPERIENCE PREFERRED
Effective written and oral communication skills Technically savvy in all Microsoft Office products, in particular Excel Ability to be a great teammate Displays an outgoing and positive attitude toward assignments and colleagues Ability to preform calculations: addition, subtraction, percentages, etc.

PHYSICAL WORKING CONDITIONS
Sitting in a comfortable position with frequent opportunity to move about Sitting in a comfortable position with frequent opportunity to move about the department and traverse the hospital campus. Examples: executive, management, administrative and secretarial positions.

ENVIRONMENTAL WORKING CONDITIONS
Comfortable indoor area Located in a comfortable indoor area. Examples: executive, management and secretarial positions.

HAZARDS OSHA
Category 3 Tasks that involve no exposure to blood, body fluids, tissues, or other potentially infectious materials and Category 1 tasks are not a condition of employment.

POSITION & UNIT ACCOUNTABILITIES

Develops/Manages Processes & Systems - Assists with contracts Assists in the negotiation of physician managed care contracts, analytics, and financial modeling.Upholds Standards/Expectations of HSS Staff - Coordinates enrollment Coordinates physician enrollment in managed care plans.Upholds Standards/Expectations of HSS Staff - Ensures compliance Ensures compliance of managed care companies with negotiated contracts.Upholds Standards/Expectations of HSS Staff - Resolves payor issues Follows-up and resolving payment issues with Insurance Payors.Upholds Standards/Expectations of HSS Staff - Acts as liaison Acts as a liaison between physician offices and Insurance Payors.Upholds Standards/Expectations of HSS Staff - Assists with meetings Schedules, coordinates, and documents for all PHO related meetings.Maintains Documentation & Manages Information - Maintains tracking logs Creates and maintains tracking logs for Insurance Payor issues and accountability for closing out items.Upholds Standards/Expectations of HSS Staff - Oversees PHO line Oversees PHO phone line, answers and responds to inquires, and assist with urgent physician office issues.Upholds Standards/Expectations of HSS Staff - Attendance Maintains satisfactory attendance record.Upholds Standards/Expectations of HSS Staff - Maintains punctuality Reports for duty punctually.Upholds Standards/Expectations of HSS Staff - Adjusts to change Adjusts to changing situations and work assignments.

EDUCATION REQUIRED
High School Diploma or equivalent (G. E.D.), may include specialized or vocational courses

EDUCATION PREFERRED
Bachelors

CERTIFICATIONS/LICENSURE REQUIRED


CERTIFICATIONS/LICENSURE PREFERRED
Coding certification and/ or clinical licensure

SKILLS REQUIRED


SKILLS PREFERRED

Non-Discrimination Policy
Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.