Denial Management Specialist, Department of Patient Financial Services - BronxCare Health System : Job Details

Conduct reviews of denied claims and audits of registration/insurance verification activities to improve denial rates and enhance revenue. Provide in-service training on insurance identification, verification, and reporting. When directed, perform audit duties under the guidance of the Compliance Program.

• Establish and maintain positive relationships with patients, visitors, and staff. Interact professionally and courteously, maintaining a positive public perception of Bronxcare Health System.
• Participate in Performance/Quality Improvement activities, including data collection, analysis, risk management, claims processing, and CQI team support, adhering to safety, security, infection control, and customer service policies.
• Collaborate with Clinic Administration to increase revenue by reducing payment denials and system bill holds. Keep the Bill Hold Tracker updated (Pre & Post Billing).
• Develop corrective action plans with Clinic Operations to improve insurance identification and reporting processes.
• Coordinate with Patient Financial Services (PFS) and Information Services to enhance communication, tracking, and reporting of denials, holds, and activities.
• Maintain a Clinic Insurance Eligibility Hotline for questions regarding financial eligibility.
• Work with clinics and PFS to ensure timely, complete, and accurate billing through improved communication and feedback.
• Inform clinics of policy, system, and operational changes related to insurance, eligibility, and reporting, including updates on Managed Care Payers and Medicare.
• Maintain and reconcile daily therapy services.
• Assist clinics with account updates and information reporting.
• Perform in-service training on insurance identification and reporting; conduct coaching and performance reviews across clinic locations.
• Ensure provider credentialing information is consistent across systems and report discrepancies to management.
• Identify operational issues, report to management, and recommend corrective actions to help drive revenue.
• Identify and report specific reason codes for 277 responses daily to billing managers.
• Monitor productivity and edits weekly to identify spikes; implement workflow changes to improve efficiency.
• Prepare registration reconciliation reports with various departments.
• Review miscellaneous insurance reports daily to identify claims requiring correction.
• Review daily interface rejection reports promptly.
• Scan authorizations and correspondence into the DMS system.

• At least five (5) years of hospital or healthcare patient accounts experience.
• High School diploma or GED; Bachelor's degree preferred.
• Basic computer skills.