The Denial Resolution Specialist II is responsible for reviewing, analyzing, and resolving complex claim denials by communicating with payers, hospital departments, and patients. They also identify denial trends, train staff on payer navigation, and ensure accurate claim resubmission in compliance with regulatory standards.
The analyst is responsible for the selection, development, implementation, and maintenance of clinical application software to meet organizational needs. They also lead cross-functional projects, troubleshoot system issues, and collaborate with stakeholders to configure application features.
Performs benefit investigations, submits prior authorizations, and manages patient outreach regarding insurance decisions. Coordinates prescription delivery and maintains medication inventory while assisting with quality improvement projects.
The specialist serves as a regulatory gatekeeper for charge generation and coding compliance while providing support to clinical staff regarding billing and revenue integrity. They are also responsible for developing educational materials and conducting training programs on documentation and coding protocols.
The Financial Clearance Specialist is responsible for verifying patient demographic, financial, and insurance information to ensure coverage prior to medical services. They also collect patient liabilities, process payments, and manage appointment scheduling to facilitate smooth department operations.
The role involves interpreting clinical and diagnostic documentation to assign accurate ICD-CM, CPT, and ICD-PCS codes for outpatient and emergency medicine encounters. The coder ensures documentation substantiates assigned codes and maintains a minimum accuracy rate of 95% for optimal reimbursement.
Serve as the Medical Director of MCPAP for Moms, providing clinical consultation to perinatal care providers across Massachusetts. Collaborate with national Perinatal Psychiatry Access Programs and engage in academic activities including teaching and research.
Responsible for interpreting medical record data to assign appropriate ICD-CM and CPT codes for physician and facility charges. The role involves abstracting data into computer systems and collaborating with clinical staff to resolve documentation gaps.
Responsible for verifying patient insurance and demographic information to ensure financial clearance before medical services are rendered. This includes collecting co-pays, providing cost estimates, and resolving insurance issues to minimize financial risk.
The Application System Specialist serves as a subject matter expert for Workday Recruiting and Reporting, responsible for application configuration, support, and solution design. This role leads cross-functional projects, manages critical incidents, and drives continuous improvement through workflow optimization and vendor collaboration.
