Denial Resolution Specialist I

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Exemption Status:

Non-Exempt

Schedule Details:

Monday through Friday

Scheduled Hours:

8a-4:30p

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

99940 - 5404 Denials

Union:

SHARE (State Healthcare and Research Employees)

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Responsible for reviewing, analyzing and initiating appropriate action for denial resolution by communicating with payers, hospital departments and patients for data as assigned

Responsible for reviewing, analyzing and initiating appropriate action for denial resolution by communicating with payers, hospital departments and patients for data as assigned.

Major Responsibilities:

• Completes appropriate actions needed for an effective appeal including conducting authorization research, rebilling, and balance write off or transfer to next responsible party. Escalates issues as appropriate.
• Corresponds with third party payers, hospital departments, and patients to obtain information required for denial resolution following payer timelines. Releases information following Federal, State and Hospital guidelines.
• Uses assigned work queues and prioritization standards and guidelines to perform denial resolution follow up.
• Uses reference material to troubleshoot payer issues and increase understanding of denial resolution techniques. Reference payer websites as needed.
• Analyzes and researches the denial reasons for each assigned denial code.

Position Qualifications:

License/Certification/Education:

Required:

• High School diploma

Experience/Skills:

Required:

• Previous Revenue Cycle knowledge in one of the following areas including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party Reimbursement.
• Ability to perform assigned tasks efficiently and in timely manner.
• Ability to work collaboratively and effectively with people.
• Exceptional communication and interpersonal skills.

Preferred:

• One or more years of experience in health care billing functions.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at We will make every effort to respond to your request for disability assistance as soon as possible.