Denials Management Specialist - Remote
The University of California, San Diego
About this position
Position Description
UC San Diego Health's Revenue Cycle department supports the organization's mission to deliver outstanding patient care and to create a healthier world — one life at a time. We are a diverse, patient-focused, high-performing team with a commitment to quality, collaboration, and continuous improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service. improvement that enables us to deliver the maximum standard of care to our patients. We offer challenging career opportunities in a fast-paced and innovative environment and we embrace individuals who demonstrate a deep passion for problem-solving and customer service. This position supports essential facility revenue cycle operations with primary focus on denials resolution, payer follow-up, reimbursement recovery, and account receivable reduction. The role is responsible for researching denied accounts, identifying root causes, resolving payer barriers, submitting appeals or reconsiderations when appropriate and escalating complex issues that requiring coding, clinical, billing, contract, or payer intervention. Current productivity and account resolution metrics reflect approximately $3+ million in monthly net cash collections and $13.3 million in gross cash account receivable resolution.
Qualifications
Minimum of 4 years of recent healthcare revenue cycle experience, preferably in hospital/facility billing, payer follow-up, collections, denials, or account resolution including experience researching and resolving denied, unpaid, or underpaid healthcare claims. HFMA Certified Revenue Cycle Representative (CRCR) required or within 120 days of employment. Experience with hospital billing and collections, including specialty billing, reimbursement follow up, denial and claim rejection trending and follow up. Expert knowledge of medical insurance and State and Federal rules and regulations related to billing Insurance Claims. Knowledge of accounting and cash handling principles and various billing documents and claim forms. Extensive knowledge in Insurance claims appeals with extensive experience in use and understanding of coding as well as demonstration of coding guidelines including medical and surgical terminology. Excellent verbal and written communication skills and able to promote and maintain superb communication in the following relationships: peer to peer, management, third party payors, patients and departments within UCSD. Must demonstrate reliability, communicate constructively, actively listen, function as an active participant, share openly and willingly, cooperate and pitch in to help, exhibit flexibility, show commitment to the team(s), work as a problem-solver, and treat others in a respectful, professional and supportive manner. Expertise using Excel, Word and Outlook. Knowledge of home infusion and pharmacy billing with strong knowledge base of Specialty Infusion billing. A self-starter who is accountable and requires minimal direction and supervision; a person who is open to new ideas; and a creative and flexible individual who is comfortable working in a large, complex organization.