Government Affairs Representative jobs in Sioux City, IA

Work Status Details: Full Time | 80.00 Hours Every Two Weeks
Exempt from Overtime: Non-Exempt
Shift Details: 8:00 - 4:30 - Some flexibility
Department: Government Insurance | Reports To: Manager-Patient Financial Services-Government

The mission of Faith Regional Health Services is to serve Christ by providing all people with exemplary medical services in an environment of love and care.

Summary:

Job Summary : The Denials Coordinator is responsible for identifying and managing claim denials due to registration, coding, health plan contract reimbursement parameters, EHR workflows and other variances. Denials Coordinator will also work with Revenue Cycle Steering Committee and facility departments to implement process improvements for denial and write off reduction strategies.

The listing of job duties contained in this job description is not all inclusive. Duties may be added or subtracted at any time due to the needs of the organization.

Responsibilities:

Essential Job Duties and Responsibilities:

1. Reviews reports from claim clearinghouse as well as Explanations of Benefits and Remittance Advices to identify denials, where they occurred, what health plans were involved and how to rectify or record the denial.

1. Review each denied claim with respect to services provided, physician orders, authorizations obtained and patient demographics.

1. Responds to denials and files appeals as necessary or refers denial on to clinical or patient billing areas if appropriate.

1. Review all relevant industry information with respect to services provided, documentation required and denial management.

1. Report to Revenue Cycle Steering Committee, finance, and involved departments all denials with appropriate categorization.

1. Compile a monthly denial findings report documenting findings; to include department, denial issue, and dollar amount, along with patient account number.

1. Assist nursing and ancillary services in identifying areas resulting in lost revenue and inadequate documentation. Assist nursing and ancillary departments in implementing corrective actions to eliminate lost revenue.

1. Identify deficient physician documentation by sending a report for review.

1. Identify CDM issues identified as part of an audit. Work with the department to get new charge, description change, J code added etc. to help reduce future denials.

10. Work with the business office (PFS) office to address insurance denials that are related to charge entry or documentation. This could include missing charges, incorrect dates of service, admission dates, large quantity verification on claim, etc.

Hours will be dependent on patient census and workload. Ability and willingness to work a flexible schedule, to include after-hours and weekends as necessary.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other information:

Job Requirements:

The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required.

EDUCATION:

GED or High School Diploma preferred. 

Associate Degree preferred. 

EDUCATION FIELD OF STUDY:

Medical Billing and Coding preferred. 

EXPERIENCE:

3-5 years of previous experience in Medical Billing preferred. 

3-5 years of previous experience in Customer Service preferred. 

SKILLS:

Language Skills -- ability to read, write, speak, and understand the English language -- required.

Strong understanding of Microsoft Word, Excel, and PowerPoint required. 

KNOWLEDGE:

Knowledge of Hospital and Physician charge processes preferred. 

Knowledge of Billing regulations and medical coding preferred. 

Faith Regional Health Services is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.