Denials Specialist PRN

Here, it's different. Come join us.

Children's Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years.

Here, the nation's brightest nurses, physicians, scientists, researchers, therapists, and care providers are creating the future of child health. With an optimist's outlook, a trailblazing spirit, and a celebrated history, we're making new strides every day.

We've been Magnet-designated four times by the American Nurses Credentialing Center and are consistently recognized among the best of the best pediatric hospitals with #1 rankings in Colorado and the region by U.S. News & World Report.

As a national leader in pediatric care, we serve children and families from all over the nation. Our System of Care includes four pediatric hospitals, 11 specialty care centers, 1,300+ outreach clinics and more than 10,000 healthcare professionals representing the full spectrum of pediatric care specialties.

Here, we know it takes all of us, every role, to deliver the best possible care to each child and family we treat.

That's why we build our teams toward a foundation of equity in access, advancement, and opportunity. We know teams of individuals with different identities and backgrounds can nurture creativity and innovation. We know we can see, treat, and heal children better when our team reflects the diversity of our patient population. We strive to attract and retain diverse talent because we know a truly inclusive and equitable workforce will help us one day realize our most basic calling: to heal every child who comes through our doors.

A career at Children's Colorado will challenge you, inspire you, and motivate you to make a difference in the life of a child. Here, it's different.

Position supports all denials management functions for Patient Financial Services, maintains and updates denials management data, and conducts analyses for trending and reporting. The position will also be responsible for conducting root-cause analysis of denials, interacting and meeting with departments throughout the hospital requiring assistance in addressing denials, be responsible for working denials that are escalated to them for review and resolution, work with PFS or other departments to develop and maintain all denials management training and guidelines. This position requires strong partnering with management and staff in PFS, Ambulatory Services, Case Management, Patient Access and HIM.

Department Name: Patient Financial Services
Job Status: PRN as needed
Shift: Day Shift - Since this is PRN we can be flexible on hours worked; however, we are open for business between the hours of 6am-5pm, M-F , Hybrid after 90 days in office training

• General Work Experience: Three to five years prior experience in a healthcare or related field (front-line clinic,billing office and/or admissions department) with exposure to billing and denials management. Must have familiarity with data analysis and reporting and must be proficient with Microsoft Excel. The individual must exhibit an ability to participate in an environment that promotes staff development, productivity, satisfaction and efficiency. The individual must be customer service oriented (internal/external), exhibit strong
  communication skills - written and verbal, display an ability to multi-task, and use of general office equipment and systems are required.
• Preferred Education - Bachelors
• Preferred Education Field of Study - Business
• Preferred Experience: 3 to 5 years denials management & analysis
• Preferred Experience: 3 to 5 years hospital billing and claims follow-up
• Required Experience: 1 to 2 years hospital billing and claims follow-up

Population Specific Care
No Direct Patient Care

Denials Analysis & Resolution: 1) Conducts root-cause analysis of denials to determine
where improvements within PFS or other departments may be necessary. 2)
Collaborates with and provides support to PFS staff and management in appeals
including, but not limited to, follow-up with departments where letters of medical
necessity are required or retro-authorizations are needed, staff escalation of appeals
requiring action or drafting letters to payors, follow-up with payors on denials, etc... 3)
Researches contract terms/interpretation and compiles necessary supporting
documentation for appeals. 4) Timely follow-up to insure appeals are met within the
allowed time periods as dictated by the various payors.
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Denials Training & Education: 1) Responsible for supporting teams in denials
education and training. Supporting staff in most effective practices for denial
management. 2) Responsible for developing documentation and guidelines in denials
management - supported by PFS Business Analyst II and management.
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Denials Trending & Reporting: 1) Supports all users with denials management
software. 2) Updates and maintains denials trending reports. 3) Provide information
and support monthly Denials Meeting. 4) Conduct analysis and develop reports of
denial patterns by payors, denial types, or departments. 5) Works with systems to
determine payment problems and billing and collection problems. Assists in
communicating those problems to various components within PFS and other
departments.
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Scope/Organizational Responsibility
Financial Accountability: a -Responsible for personal use of resources, supplies and materials, tracking personal spending and submitting accurate expense reports.
Impact of Decisions: c -Decisions limited to implementation and completion of departmental functions, goals and projects, and exert some influence on cross-departmental work flow and outcomes.
Judgment: b -Sets priorities for own work within overall guidelines; manages own workflow in cooperation with others.

Ability to Perform Essential Functions of the Job

Physical Requirements
Audio-Visual: Color Discrimination: Good
Audio-Visual: Depth Perception: Good
Audio-Visual: Far Vision: Good
Job Description Page 1 of 2
Audio-Visual: Hearing: Good
Audio-Visual: Near Vision: Good
General Activity: Drive: None
Motion: Bend: Up to 1/3 of time
Motion: Carry: Up to 1/3 of time
Motion: Climb: Up to 1/3 of time
Motion: Crawl: Up to 1/3 of time
Motion: Lift: Up to 1/3 of time
Motion: Push: Up to 1/3 of time
Motion: Reach: Up to 1/3 of time
Motion: Squat/Crouch: Up to 1/3 of time
Environment
Exposure: Exposure to chemicals: Occasional.
Exposure: Exposure to noise/vibration: Occasional.
Mental and Emotional Requirements: Independent discretion/decision making.
Mental and Emotional Requirements: Makes decisions under pressure.
Mental and Emotional Requirements: Manages stress appropriately.
Mental and Emotional Requirements: Works with others effectively.

It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information.

The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

As a Children's Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid sick leave and a robust wellness program.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children's Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.