Denials Management Assistant

St. Luke’s University Health Network•Allentown, PA

About The Position

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.

Requirements

Associate Degree in Business or Secretarial Field preferred, or High School Diploma with courses in Medical Terminology preferred.
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.

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.