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St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
The Denials Management Assistant is responsible for providing clerical support for the Denials Management Program. Supports the RAC/MAC and Commercial denials appeal process by maintaining good documentation in the appropriate systems and good communication between the Physician Advisor Director, Denials Management Manager, and Denials Management Team members in order to facilitate appeal letter responses throughout all levels of determination.
JOB DUTIES AND RESPONSIBILITIES:
- Coordinate all activities associated with Commercial Insurance and RAC/MAC requests and appeals inclusive of, but not limited to:
- Completion of appropriate forms and face letters
- Obtaining signature from Denials Management Manager
- Compiling appeal packets
- Processing of packets via certified mail
- Responsible for tracking hand-off of appeal information among departments and notifying both the Denials Management Manager and the PA Director regarding timelines.
- Responsible for tracking Commercial Insurance and RAC/MAC timelines for requests and RAC/MAC and Commercial Insurance response.
- Communicate with all external entities involved in the Commercial Insurance and RAC/MAC process, if applicable.
- Coordinate scheduling of ALJ level appeals with PA Director’s administrative assistant.
- Documentation of activity and outcomes in designated computer systems.
- Maintain open communication between Denials Management Manager, Physician Advisor, Case Management Director, along with other associated departments.
- Data abstraction and entry related to all levels of Commercial Insurance and RAC/MAC appeals and Denials Management Program outcomes.
- Assists in preparing reports regarding denials to include volumes, number of appeals, case resolution, and impact on revenue and trending.
PHYSICAL AND SENSORY REQUIREMENTS:
Sitting for one to two hours at a time, stand for two to three hours at a time, walk on all surfaces for up to five hours per day, and climb stairs. Must be capable of driving a car. Fingering and handling objects frequently. Occasionally firmly grasp, twist, and turn objects weighing up to 75 pounds. Occasionally stoops, bends, squats, kneels, and reaches above shoulder level. Must have the ability to hear as it relates to normal conversations and high and low frequencies, and to see as it relates to general and peripheral vision. Must have the ability to touch as related to telephone and computer keyboard.
EDUCATION:
Associate Degree in Business or Secretarial Field preferred, or High School Diploma with courses in Medical Terminology preferred.
TRAINING AND EXPERIENCE:
Three to five years related health care experience. Proficiency in Microsoft Word/Windows, Excel, and the ability to learn how to work in multiple computer software systems. Ability to enter data and manage data base with 100% accuracy. Ability to work within strict deadlines.
Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!
St. Luke's University Health Network is an Equal Opportunity Employer.
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