Denials Management Assistant, Per Diem

St. Luke's University Health Network

Allentown, PA

JOB DETAILS
SKILLS
Administrative Skills, Apple Macs, Case Management, Communication Skills, Computer Software, Computer Systems, Data Entry, Database Administration, Denials Management, Documentation, Financial Trend Analysis, Healthcare, Healthcare Providers, High School Diploma, Insurance, Keyboards, Low Frequency (LF), Medical Terminology, Microsoft Excel, Microsoft Windows Operating System, Microsoft Word, Nursing, Reporting Skills, Vehicle Driving
LOCATION
Allentown, PA
POSTED
10 days ago


St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The Denials Management Assistant is responsible for providing clerical support for the Denials Management Program. Supports the RAC/MAC and Commercial denials appeal process by maintaining good documentation in the appropriate systems and good communication between the Physician Advisor Director, Denials Management Manager, and Denials Management Team members in order to facilitate appeal letter responses throughout all levels of determination.

JOB DUTIES AND RESPONSIBILITIES:

  • Coordinate all activities associated with Commercial Insurance and RAC/MAC requests and appeals inclusive of, but not limited to:
  •     Completion of appropriate forms and face letters
  •     Obtaining signature from Denials Management Manager
  •     Compiling appeal packets
  •     Processing of packets via certified mail
  • Responsible for tracking hand-off of appeal information among departments and notifying both the Denials Management Manager and the PA Director regarding timelines.
  • Responsible for tracking Commercial Insurance and RAC/MAC timelines for requests and RAC/MAC and Commercial Insurance response.
  • Communicate with all external entities involved in the Commercial Insurance and RAC/MAC process, if applicable.
  •  Coordinate scheduling of ALJ level appeals with PA Director’s administrative assistant.
  • Documentation of activity and outcomes in designated computer systems.
  • Maintain open communication between Denials Management Manager, Physician Advisor, Case Management Director, along with other associated departments.
  • Data abstraction and entry related to all levels of Commercial Insurance and RAC/MAC appeals and Denials Management Program outcomes.
  • Assists in preparing reports regarding denials to include volumes, number of appeals, case resolution, and impact on revenue and trending.

PHYSICAL AND SENSORY REQUIREMENTS:

Sitting for one to two hours at a time, stand for two to three hours at a time, walk on all surfaces for up to five hours per day, and climb stairs. Must be capable of driving a car. Fingering and handling objects frequently. Occasionally firmly grasp, twist, and turn objects weighing up to 75 pounds. Occasionally stoops, bends, squats, kneels, and reaches above shoulder level. Must have the ability to hear as it relates to normal conversations and high and low frequencies, and to see as it relates to general and peripheral vision. Must have the ability to touch as related to telephone and computer keyboard.

EDUCATION:

Associate Degree in Business or Secretarial Field preferred, or High School Diploma with courses in Medical Terminology preferred.

TRAINING AND EXPERIENCE:

Three to five years related health care experience. Proficiency in Microsoft Word/Windows, Excel, and the ability to learn how to work in multiple computer software systems. Ability to enter data and manage data base with 100% accuracy. Ability to work within strict deadlines.

Please complete your application using your full legal name and current home address.  Be sure to include employment history for the past seven (7) years, including your present employer.  Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable.  It is highly recommended that you create a profile at the conclusion of submitting your first application.  Thank you for your interest in St. Luke's!!







About the Company

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St. Luke's University Health Network

St. Luke's University Health Network is a regional network of hospitals, physicians and other related organizations providing care primarily in Lehigh, Northampton, Monroe, Carbon, Schuylkill, Bucks, Montgomery and Berks counties in Pennsylvania and Warren County in New Jersey.

The Network provides services at more than 150 sites. St. Luke's University Health Network is comprised of six hospital sites. The Network includes:

  • More than 80 owned physician-practice sites
  • 300 employed primary care/specialist physicians
  • Various outpatient testing and service facilities
  • Home health
  • Hospice services (inpatient and outpatient)
  • Largest ambulance provider in Bucks County and second largest in Lehigh County
  • Other related organizations
  • 57,500+ annual admissions
  • 195,000 annual emergency room visits
  • 1,325 physicians on the Medical Staff (96 percent board-certified)
  • 8,600+ employees
  • More than 1,350 volunteers

Areas of exceptional medical expertise include:

  • Level 1 Adult Trauma Center: fully accredited by Pennsylvania Trauma Systems Foundation; 2,400+ annual trauma cases; St. Luke's 1.75 percent mortality rate represents top decile performance, significantly better than peer group as measured by National Trauma Data Bank of the American College of Surgeons; aeromedical transport services
  • Oncology: first and only cancer program in Pennsylvania to receive American College of Surgeons' highest quality recognition for three consecutive years; only Pennsylvania program to receive award in 2010; region's only fellowship-trained surgical oncologists; advanced programs for melanoma (internationally recognized melanoma investigator), lung, breast, prostate, gynecologic and gastrointestinal cancers and tumors of the brain and spine
  • Cardiology and Cardiovascular Surgery: multiple-year recipient of highest rating for cardiac bypass surgery, represents top decile performance achieved by only 10 percent of U.S. hospitals (Society for Thoracic Surgery); region's first Joint Commission certified Heart Failure Program; comprehensive surgical services excluding heart transplants
  • Neuroscience: accredited Stroke Center; additional Centers of Excellence include: Balance Center, Headache Center, Memory Disorders Center, Multiple Sclerosis Center, Sleep Disorders Center
  • Orthopaedics: advanced expertise in total joint replacement and reconstruction, computer-assisted minimally invasive surgery, primary and reconstructive surgery of the spine, sports injuries, diseases and conditions of the hand and elbow, traumatic injuries
  • Women's/Children's Health: high-risk pregnancy; the region’s busiest obstetrical service; two neonatal intensive care units; pediatric specialty care provided by St. Christopher's Hospital for Children.
  • Robotic/Minimally Invasive Surgery: one of the nation's most experienced robotic surgical teams
  • Radiology: designated international General Electric Healthcare Show Site for imaging technology; designated Breast Imaging Center of Excellence by American College of Radiology
  • Bariatric Surgery: designated Center of Excellence by American Society for Metabolic and Bariatric Surgery and Surgical Review Corporation

St. Luke's offers an exceptional benefit plan for employees. Our values are reflected in all we do for patients, each other and the community:

Pride - We take pride in our accomplishments and in our organization.

Caring - We show consideration for others and their feelings. We treat others as we want to be treated.

Respect - We recognize the value, diversity and importance of each other, those we serve and the organization.

Accountability - We are responsible to make decisions and solve problems in a timely and effective manner.

Flexibility - We adapt to the changing needs and expectations of those we serve.

Teamwork - We work together to improve quality.

The mission of St. Luke's University Health Network is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

COMPANY SIZE
5,000 to 9,999 employees
INDUSTRY
Healthcare Services