Prebill Denials Coordinator in San Antonio at Parallon

Date Posted: 10/1/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    San Antonio
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    10/1/2018

Job Description

Prebill Denials Coordinator
 
Job Summary – The Prebill Denials Coordinator will serve as the SSC liaison for the Denial Management Action Team (DMAT) Project and identify areas for continued process improvements through data and reporting analysis that will further decrease new denials, final write off denials, and prebill denials. Works with SSC leadership, Division Leadership and others on process improvement opportunities.
 
Supervisor – Prebill Denials Director/Manager
 
Supervises not applicable
 
Duties (included but not limited to):
 
•         Serve as the SSC Liaison for the Denial Management Action Team (DMAT) Project
•         Submits standard monthly denial reports to Division Denial Management
•         Monitor, record, communicate and escalate denial action items based on DMAT project findings to SSC   leadership
•         Serve as scribe for the DMAT facility meeting if requested by Division, Facility, or SSC leadership
•         Facilitate the SSC DMAT meetings, along with others as assigned by SSC Leadership.
•         Assist with identifying areas for continued process improvement to reduce denial via Division, Facility, and SSC DMAT meetings as well as reporting and data analysis.
•         Analyze denial trends identified via applicable reports such as EDW, Visual Insight, special queries and other workflow tools
•         Provide education and training as needed
•         Establish and maintain relationships with all customers, including: SSC Leadership, Hospital Leadership, Division Leadership and other customers
•         Demonstrates knowledge of regulatory requirements, Ethics and Compliance policies, and quality initiatives; monitors self-compliance and works with management to implement process changes needed to meet compliance and regulatory updates, along with quality initiatives
•         Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous
•         Actively seeks ways to control costs without compromising quality of services delivered
•         Adheres to established policy and procedure and escalates issues through the established Chain of Command
•         Demonstrates commitment to teamwork and cooperation
•         When time permits, assist the Prebill Denial Unit by working assigned accounts in the PDU Tool.
•         Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
 
 
•         Other duties as assigned
 
KNOWLEDGE, SKILLS & ABILITIES
 
•         Technical Expertise – Some understanding of healthcare including knowledge of healthcare terms and accounts receivable processes and basic payer rules, which affect reimbursement and/or compliance requirements. Understands basic payer rules which affect reimbursement and/or compliance requirements, Understands case management operations and workflow as it relates to the communication and authorization process with all Payors (except Medicare).
•         Organization - proactively prioritizes needs and effectively manages resources
•         Communication - communicates clearly and concisely, verbally and in writing. This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately.
•         Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
•         Interpersonal skills - able to work effectively with other employees, patients and external parties
•         PC skills - demonstrates proficiency in Microsoft Office applications and others as required
•         Leadership - guides individuals and groups toward desired outcome by providing training, advice and feedback to assist/support employees in achieving established performance standards
•         Tactical execution - assist in monitoring operational processes and making recommendations for changes/adjustments as needed during the implementation or change to new products or processes
•         Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
•         Basic skills - demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes, have ability to work quickly and accurately in a fast-paced environment while managing multiple demands, ability to work both independently and collaboratively as a team player, adaptability, analytical and problem solving ability and attention to detail and able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately.
 
 

Job Requirements

EDUCATION
 
•         Associates Degree or above in Business, Finance, Accounting or related field
•         Equivalent work experience may substitute degree requirement
 
EXPERIENCE
 
•         One year of related experience required. Experience in the following areas: appeals, denials, managed care, verifications/notification, precertification, project management experienced preferred.
•         Some travel may be required.
 
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