Everything we do is underscored by a why — and that why is one another.

Location:

Altru Health System PO Box 6002 Grand Forks, ND 58201

Pay Range: $18.82 - $28.23

Summary:

The Lead Denial Management Specialist serves as resource in daily operations and participates in the development and implementation of policies and procedures. This position provides information on denial data and tracks denials by third party payers and PPO networks.

Essential Job Functions:

• Assists with development and implementation of an appeals process for claims recovery strategies that will reflect performance improvements and compliance.

• Works with Payer Enrollment ensuring provider/location are enrolled correctly with the payers.

• Assists in maintenance, enhancement and problem solving of the Epic patient accounting systems by going thru denials and getting edits in charge review or claim edits to prevent denials.

• Reviews and tracks monthly adjustment codes to provide input to department, leadership and physicians, preventing unnecessary adjustments.

• Creates reports and dashboards on denial trending and financial impact that can be utilized to reflect performance improvements and compliance.

• Assists the Manager/Supervisor in defining new requirements, suggesting solutions and testing additional systems or enhancements. Identifies delays, inefficiencies and errors which hinder the claim process.

• Provides information on denial data on a regular schedule. Tracks denials by third party payers and PPO networks to determine discrepancies with AHS patient access and billing systems. Shares information with staff and departments involved to institute corrective actions.

• Promotes the activities, initiatives and goals made by Altru Health System and the Finance Team. Supports and enforces the policies and procedures that guide the duties and tasks performed daily.

• Performs other duties as assigned or needed to meet the needs of the department/organization.

Education:

• Preferred: Associates - Business- OR -Associates - Related Field

Work Experience:

• Required: A minimum of 2 years Related Experience

Language Requirements:

This position requires proficiency in reading, writing, and speaking English to ensure effective communication in the workplace and with patients, families, and team members.

Physical Demands :

• Sit: Continuously (67-100%)

• Stand: Occasionally (5-33%)

• Walk: Occasionally (5-33%)

• Stoop/Bend: Occasionally (5-33%)

• Reach: Frequently (34-66%)

• Crawl: Not Applicable

• Squat/Crouch/Kneel: Occasionally (5-33%)

• Twist: Occasionally (5-33%)

• Handle/Finger/Feel: Continuously (67-100%)

• See: Continuously (67-100%)

• Hear: Continuously (67-100%)

Weight Demands:

• Lift -Floor to Waist Level: Sedentary (<10 pounds)

• Carry: Sedentary (<10 pounds)

• Push/Pull: Sedentary (<10 pounds)

• Slide/Transfer: Sedentary (<10 pounds)

Working Conditions:

• Indoor: Continuously (67-100%)

• Outdoor: Not Applicable

• Extreme Temperature: Not Applicable

Driving Requirement Definitions:

• Professional Drivers: Persons who drive as their main responsibility OR transport passengers or hazardous materials.
• Frequent Drivers: Persons whose main responsibility is not driving, but drive daily or almost daily.
• Occasional Drivers: Persons who drive from once per month to as frequently as once per week.
• Infrequent Drivers: Persons who are generally not expected to drive.

Driving Requirement for this position:

Infrequent Driver

Reference ID: R7892

Making a real difference. For one another.

To take the best care of our patients and community — including friends, family, and neighbors — we need people who are committed to growth, excellence, and one another.

At Altru, you’ll find a culture where support and teamwork are at the heart of what we do. You’ll have opportunities to advance your skills, work with the latest technologies, experience the fulfillment that comes from giving back, and take your career wherever you want it to go.

Join our team and be a part of a small community with a big heart.

Altru offers a comprehensive benefits package to its full- and part-time employees. Excellent benefits include a health plan and 401(k) retirement plan. Other benefits include a dental plan, vision plan, life and disability insurance, education assistance, paid time off (PTO)