About Us
McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 20,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio.
Denials Management Assistant
Position Summary:
Responsible for providing assistance to the Denials Team in the coordination of CMS and Third-party payer denials/appeals, as well as, performing clerical functions to ensure the efficient operation of the department.
Essential Functions and Responsibilities as Assigned:
- Assists with the team to determine the appropriate hospital setting (inpatient vs. observation) based on medical necessity.
- Maintains current knowledge of hospital billing processes and participates in the resolution of retrospective billing issues including appeals, PACER authorization, third party payer certification, and denied cases.
- Assists in performs retrospective denial management-related activities and functions to ensure that appropriate data are tracked, evaluated, and reported.
- Communicates with A/R, denials, finance/billing, and HIM to render appropriate information needed to appeal/secure reimbursement dollars.
- Assists with monitoring the effectiveness/outcomes of denial management. Provides prompt feedback regarding payor denials to the team.
- Attends meetings and prepares agendas and minutes.
Qualifications:
Required
· High school diploma
· Two years of clerical experience
· One-year experience in a heath care environment utilizing medical terminology or have completed a college level course in medical terminology
Preferred:
- Associate degree in healthcare related field
- Two years of case management or utilization review, billing, or coding experience
· Three years of recent experience doing third party payer certification
- Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross or equivalent through the Military Training network (MTN)
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
