Job Type: Full-Time
Work Shift: DAY
Work Week: M - F Specialized inpatient care for those patients requiring a longer hospital stay
Note: This position is located at our Continuing Care campus at: 701 S. Fry Road, Katy, TX 77450
The Appeals Denials Specialist is responsible for reviewing accounts which have been denied or underpaid by third party payers and to resolve the issues resulting in denial/underpayment and to formally appeal. Must maintain a strong working knowledge of managed care contractual agreements pertinent to denials and appeals processes. Excellent writing, oral and interpersonal communication skills are required of this specialist who is responsible for communicating information and for interacting, using various media, with all levels of healthcare professionals.
System and department specific ICARE values
INTEGRITY: We are honest and ethical in all we say and do.
COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
ACCOUNTABILITY: We hold ourselves accountable for all our actions.
RESPECT: We treat every individual as a person of worth, dignity, and value.
EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.
Duties and Responsibilities are cross-referenced to the hospital's Pillars of Excellence and will be transferred to the Performance Evaluation.
PEOPLE - Weight 20%
1. Interacts with others in a supportive respectful manner.
2. Participates in projects, programs and action plans to meet department goals.
3. Acknowledges and respects individual and cultural differences.
4. Collaborates and shares knowledge to support the Methodist vision, mission and goals.
5. Takes initiative to assist others.
Job Specific Accountabilities:
6. Demonstrates articulate, professional, and effective verbal and written communication skills.
7. Self-manages behaviors to meet/exceed departmental and hospital expectations.
FINANCE - Weight 5%
1. Utilizes department resources/supplies efficiently.
2. Identifies cost saving or revenue opportunities
3. Manages time effectively to meet established timelines.
QUALITY/SAFETY - Weight 40%
1. Provides timely, high quality information.
2. Maintains and achieves the highest standards of quality, delivery of care and service.
3. Continuously measures and improves quality outcomes.
4. Demonstrates knowledge and behaviors related to environmental, employee, or patient safely requirements.
5. Complies with Business Practices standards for performance.
Job Specific Accountabilities:
6. Effectively manages inventory in accordance with departmental standards.
7. Reviews accounts, takes appropriate action, and documents per departmental standards. The reason for denial; clinical, administrative, or technical, is clearly stated on the payment documentation. Technical issues are handled by the Appeals Denials Specialist. Clinical and administrative issues are forwarded to the appropriate group for review.
8. Follows and understands Revenue Cycle fundamentals.
9. Understands Information Systems and programs as they relate to job performance.
SERVICE - 10%
1. Responds promptly to internal and external customer requests.
2. Strives to exceed patients and co-workers expectations.
3. Provides a caring and supportive environment for patients and guests.
4. Demonstrates service standards (e.g. ServicePRIDE/MethodistExperience/Service Excellence)
GROWTH/INNOVATION - 25%
1. Generates and communicates new ideas and suggestions that improve quality or service.
2. Demonstrates adaptability and flexibility in the face of changing demands.
3. Displays initiative to improve relative to job function.
4. Accepts feedback and changes behavior appropriately.
5. Approaches problems with an open mind and contributes to solutions.
Job Specific Accountabilities:
6. Effectively participates in meetings.
7. Participates in staff education opportunities.
This position description is not intended to be all inclusive, and the employee will also perform other reasonably related business duties as assigned by the immediate supervisor and other management as required. The Houston Methodist Hospital reserves the right to revise or change job duties and responsibilities as the need arises.
High school diploma/equivalent required, Bachelors degree in Business or related field preferred.
3+ years experience working with contract interpretation or related skills.
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
Good verbal and written communication skills in the English language
Strong computer skills, including Microsoft Word and Excel
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.
VEVRAA Federal Contractor – priority referral Protected Veterans requested.
Houston Methodist Continuing Care Hospital is the first specialty hospital in the Houston Methodist family. Located in the heart of the Katy community, the facility provides a special menu of services for both inpatient and outpatient care by team members called to serve with excellence and compassion:
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