Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

Pay Range:

$19.32 - $28.07

Scheduled Weekly Hours:

40

Position Overview

Denial Process Representative

JOB CODE:50346

SUMMARY (BASIC PURPOSE OF THE JOB)Analyzes all patient accounts denied of correct payment by Managed Care Payors and works with proper departments to ensure payments and collections of money owed to Capital Health (CH).MINIMUM REQUIREMENTS

Education: High school diploma or equivalent.

Experience :One year related experience.

ESSENTIAL FUNCTIONSInstructs and assists co-workers to identify and organize data relating to incorrect payments or denials for reconciliation and appeals.Frequently receives, provides, clarifies or exchanges information with Managers/Directors within department. Has frequent interaction with Case Management, Quality Resource Management, Patient Access, and Patient Accounts.Coordinates and attends denial work sessions with other hospital departments directly involved with denials process.Utilizes Denial Management software to monitor and review monthly trends prior to report distribution.Downloads and manipulates excel spreadsheets from Denial Management software to be distributed to various CH departments in order to identify denial patterns, trends, and issues.Analyzes data obtained from Denial Management software and shares information with Director and staff.Identifies trends for improvement in order to increase percentage of first pass clean claim submission.Responsible for providing weekly report of claims referred to outsource denial management vendor.Requests reports in HBOC and Aergo to gather information for purpose of identifying payment problems and trends.PHYSICAL DEMANDS AND WORK ENVIRONMENT

Frequent physical demands include: Sitting

Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion

Continuous physical demands include:

Lifting Floor to Waist 20 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing

Anticipated Occupational Exposure Risks Include the following: N/A

This position is eligible for the following benefits:

Medical Plan

Prescription drug coverage & In-House Employee Pharmacy

Dental Plan

Vision Plan

Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

Retirement Savings and Investment Plan

Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

Disability Benefits – Long Term Disability (LTD)

Disability Benefits – Short Term Disability (STD)

Employee Assistance Program

Commuter Transit

Commuter Parking

Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

Voluntary Legal Services

Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

Voluntary Identity Theft Insurance

Voluntary Pet Insurance

Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.