At Stony Brook Medicine, the Denials and Appeals Assistant will perform the daily operations of clerical support within the Care Management Department specific to responding to inpatient denial requests for appeal to commercial and governmental payers. The Denials and Appeals Assistant will be responsible for investigating all denials utilizing short stay database, insurance end of day reports, current denial worklist, financial screen and electronic medical record to ensure that denials received are actual and need to be appealed. The Denials and Appeals Assistant will work closely with the Database Administrator in the Appeals Unit on a daily basis. He or she will also interact with the Appeal Nurses, Program Coordinators, Case Managers and Department Directors and Executive Director.
Duties of a Denials and Appeals Assistant may include the following but are not limited to:
Brief Description of Duties:
Retrieve and sort incoming denials and faxes for Clinical Appeals Unit.
Respond to potential concurrent or retrospective inpatient denials
Supports the Appeals Unit effort to facilitate daily activity of denials
Identify and relay initial soft denial code to patient accounts.
Perform all data entry of Managed Care and Governmental denials into Care Management Database.
Generate list from database to communicate with HIM requests for medical records.
Communicate denial activity with patient accounts by reporting electronically through hospital RASI Viewing and Scanning program
Retrieve and log medical record received daily into database.
Prepare denial notification to accompany chart.
Ensure that the medical record is given to Appeal Nurse for review and appeal in a timely manner.
Communicate with Case Managers, Program Coordinators, and Appeals Administrator regarding pending denials including cause.
Daily follow-up with Patient Accounts.
Track and follow-up with ancillary departments regarding review of onsite and offsite review audits.
Required Qualifications: Associate Degree. At least 2 years of progressively responsible full time clerical experience. Excellent written and verbal communication skills.
Preferred Qualifications: Clerical experience in a medical, insurance, and/or finance setting. Previous experience working with a diverse population of medical and non-clinical professionals. IPRO experience. Knowledge of denials and appeals in a hospital setting. Proficient in Microsoft Access and Microsoft Office.
Special Note: This position will remain posted until filled or for a maximum of 90 days. An initial review of all applicants will occur two weeks from the posting date. For full consideration, applications must be received before the initial review date (which is within two weeks of the posting date). If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date.
Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises.
All Hospital positions are subject to changes in pass days and shifts as necessary. This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
The selected candidate must successfully clear a background investigation. Prior to start date, the selected candidate must meet the following requirements: Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services (The hiring department will be responsible for any fee incurred for examination), submit (3) written references, and provide a copy of any required New York State license(s)/certificate(s). Please be advised that failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.
The best ideas in medicine start with the best people. At Stony Brook Medicine, our highest calling is to put the power of ideas to work in our patients' lives. Stony Brook Medicine integrates and elevates all of our health-related initiatives: education, research and patient care. Stony Brook Medicine is Long Island's premier academic medical center. With 603 beds, we serve as the region's only tertiary care center and Level 1 Trauma Center, and are home to the Stony Brook Heart Institute, Stony Brook Cancer Center, Stony Brook Children's Hospital, Stony Brook Neurosciences Institute, and Stony Brook Digestive Disorders Institute. We also encompass Suffolk County's only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation's first Pediatric Multiple Sclerosis Center.
Stony Brook University is an Affirmative Action/Equal Opportunity employer. We are committed to the creation of a diverse and inclusive campus climate. We encourage protected veterans, individuals with disabilities, women and minorities to apply.
This function/position has been designated as "essential." This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.
Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor's Office of Employee Relations at (518) 474-6988 or via email at email@example.com .
IF YOU NEED A DISABILITY-RELATED ACCOMMODATION, PLEASE CALL THE UNIVERSITY HUMAN RESOURCE SERVICES DEPARTMENT AT (631) 632-6161 OR THE UNIVERSITY HOSPITAL HUMAN RESOURCES DEPARTMENT AT (631) 444-4700. IN ACCORDANCE WITH THE TITLE II CRIME AWARENESS AND SECURITY ACT, A COPY OF OUR CRIME STATISTICS IS AVAILABLE UPON REQUEST BY CALLING (631) 632-6350. IT CAN ALSO BE VIEWED ON-LINE AT THE UNIVERSITY POLICE WEBSITE AT http://www.stonybrook.edu/police
Official Job Title: TH Staff Assistant II
Job Field: Administrative & Professional (non-Clinical)
Primary Location: US-NY-Stony Brook
Department/Hiring Area: Care Management-Stony Brook University Hospital
Schedule: Full-time Shift: Day Shift Shift Hours: 8:00 AM - 4:30 PM Pass Days: Sat, Sun
Posting Start Date: Dec 19, 2019
Posting End Date: Mar 19, 2020, 3:59:00 AM
Salary: Commensurate with experience
Salary Grade: SL1
Internal Number: 1904344
About Stony Brook University
FROM ITS BEGINNINGS A HALF-CENTURY AGO, STONY BROOK UNIVERSITY HAS BEEN CHARACTERIZED by innovation, energy and progress, transforming the lives of people who earn degrees, work and make groundbreaking discoveries here. A dramatic trajectory of growth has turned what was once a small teacher preparation college into an internationally recognized research institution that is changing the world.