Denial Appeals Specialist Full Time - Patient Financial Services

City/State: New City, New York Department: Patient Financial Services_2 Work Shift: Day Work Days: MON-FRI Scheduled Hours: 8 AM-4:30 PM Scheduled Daily Hours: 8 HOURS Scheduled Weekly Hours: 40 Hourly Rate/Range: Starting at $24.00 For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

Job Summary: The denial appeals specialist is accountable for carrying out and documenting the appeals process for denied claims at Nyack Hospital. The specialist also works to maintain third-party payer relationships, a role that consists of responding to inquiries, complaints, and other correspondence. They will also work with vendors who process denials on Nyack Hospital’s behalf supplying any needed information or documentation.

They will assist Infusion services Billing Coordinator with coding and charging for services rendered. The specialist will consistently and accurately review and translate clinical documentation and medical records into different ICD-9, ICD-10 and CPT codes as needed per denial. B.Essential Job Qualifications       1. Education:       High School Diploma required; Associates preferred       2. Experience:      Minimum 2 years experience in healthcare coding required.

Billing experience required, PC knowledge required. 3. Training/Certification:  CPC or CCS required       4. Licensure:        N/A       5. Other:   Knowledge of state/federal laws that relate to contracts and to the appeal process is vital. Regularly makes complex decisions within the scope of the position, and is comfortable working independently. Job Specific Contacts General Contacts: Patients, family members, insurance carriers, banks, employers, physicians, physician’s office staff, hospital personnel, Dept of Social Services employees, Third Party vendor representatives Job Provides Direction to :  N/A  D.Environment and Demands Environmental Demands: Describe the physical environment in which the job must be performed.

Business Office environment, hospital rooms, Department of Social Services. Requires light physical effort on a regular basis, as in viewing CRT, frequent standing, walking, bending, stooping or reaching and/or occasional lifting of light items. Some minor physical inconvenience or discomfort routinely present in the work situation and occasional exposure to minor injury or other occupational hazards requiring Universal Precautions.

2. Essential Physical and Cognitive Demands, Manual Dexterity: : Describe the physical efforts, manual dexterity and cognitive skills required for the job ( i.e. ,  eye/hand coordination, lifting, pulling, walking, concentration, analysis, customer sensitivity, etc.). Requires light physical effort on a regular basis , as in viewing CRT, frequent standing, walking, bending, stooping or reaching and/or occasional lifting of light items (i.e., up to 20 lbs.).

Some irregularity in scheduled hours because of compensated overtime requirements, including weekend and/or other shift rotation. Interaction with patients and public. Part I:  Hospital-Wide Standards A. Organizational           Demonstrates adherence to Nyack Hospital “We Care” standards including: WORKING TOGETHER “ I will commit to work together in a courteous, respectful manner. I will demonstrate a positive spirit of service with all employees with whom I interact.” I will: Place team success above individual recognition.

Be receptive to new ideas and approaches within my workplace. Offer assistance generously without hesitation. EMPOWERMENT “I will be accountable, responsible, and self-directed in all aspects of my work at all times.” I will: See projects through to ensure completion. Problem solve with patients, family members, and other employees. Follow up to ensure a resolution. COMMUNICATION “I will demonstrate positive communication in a clear, courteous and appropr