Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.
As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting.
Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.
JOB TITLE - Denial Resolution Specialist
GENERAL SUMMARY OF DUTIES - The Denial Resolution Specialist will be responsible for all activities related to resolving, monitoring, and appealing claim denials received from Third Party Payers.
SUPERVISOR - Denial Resolution Manager
SUPERVISES -- None
DUTIES INCLUDE BUT ARE NOT LIMITED TO:
1. Review, identify and resolve payer denials
2. Prepare payer appeals for denied claims.
3. Ensure adjustments are posted timely and correctly for denied claims that need to be written off.
4. Track and follow up on requests for refunds or recoupments in accordance with payer requirements.
5. Practices and adheres to the "Code of Conduct" philosophy and "Mission and Value Statement."
6. Performs other duties as assigned.
KNOWLEDGE, SKILLS & ABILITIES (This position requires the following minimum requirements)
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Clear understanding and working knowledge of payer denials and appeals process.
• Clear understanding of Healthcare claims processing.
• Ability to work independently as well as in a cross-functional team environment by collaborating with others and sharing tools, skills, and knowledge.
• Solid problem-solving and analysis skills that demonstrate resourcefulness and attention to detail.
Traditional Medicare and Medicaid Collections as well as Managed Medicaid and Managed Medicare preferred
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before group s of customers or employees of organization.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
EDUCATION and/or Experience
High school diploma or equivalent; and a minimum of one year medical office experience and/or collection experience is required. A comprehensive knowledge of insurance is desired, related experience and/or training.
CERTIFICATE/LICENSE - None
PHYSICAL DEMANDS/WORKING CONDITIONS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand and walk. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus.
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom