Denial Management Specialist, Department of Patient Financial Services

Conduct review of denied claims and audits of registration/insurance verification activities to improve denial rates and enhance revenue. In-service staff on Insurance identification/verification and reporting. When directed, audit duties are under the direction of Compliance Program.

• Establish and maintain positive relationships with patients, visitors, and other employees. Interacts professionally, courteously, and appropriately with patients, visitors, and other employees. Behaves in a manner consistent with maintaining and furthering a positive public perception of Bronxcare Health System and its employees.
• Contributes to and participates in the Performance/Quality Improvement activities of the assigned department. This includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, and adherence to the rules and regulations of Bronxcare Health System regarding safety, security, risk management, infection control, and patient/customer service.
• Works with Clinic Administration to increase revenue and improve cash flow by reducing payment denials and system bill holds. Keeps the Bill Hold Tracker updated (Pre & Post Billing).
• Develops corrective action plans with Clinic Operations to improve insurance identification and reporting.
• Coordinates with Patient Financial Services (PFS) and Information Services to enhance communication, tracking, and reporting related to denials, holds, and activities.
• Maintains a Clinic Insurance Eligibility Hotline for questions regarding financial eligibility.
• Works with clinics and PFS to improve communication and feedback, ensuring timely, complete, and accurate billing.
• Informs clinics of policy, system, and operational changes related to insurance, eligibility, and reporting, including updates on Managed Care Payers and Medicare.
• Maintains and reconciles daily therapy services.
• Assists clinics with account updates and information reporting.
• Performs in-service training on insurance identification and reporting; conducts coaching and performance reviews at various clinic locations.
• Ensures provider credentialing information is consistent across systems and reports discrepancies to management.
• Identifies operational issues, reports them, and recommends corrective actions to drive revenue.
• Identifies reasons for 277 response codes and distributes this information to billing managers daily.
• Monitors and reports weekly on Epremis productivity and edits, implementing workflow changes to improve productivity as needed.
• Prepares registration reconciliation reports with various departments.
• Reviews daily miscellaneous insurance reports for claims correction.
• Reviews daily interface rejection reports promptly.
• Scans authorization and correspondence into the DMS system.

• Five (5) years of hospital/healthcare patient accounts experience.
• High School diploma or GED.
• Bachelor’s degree.
• Basic computer knowledge.