Job Title

How you move is why we're here. Now more than ever. Get back to what you need and love to do. The possibilities are endless... Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success. If this describes you then let's talk! HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment. Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise. Emp Status Regular Full time Work Shift Day (United States of America) Compensation Range The base pay scale for this position is $26.65 - $40.87. In addition, this position will be eligible for additional benefits consistent with the role. The salary of the finalist selected for this role will be determined based on various factors, including but not limited to: scope of role, level of experience, education, accomplishments, internal equity, budget, and subject to Fair Market Value evaluation. The hiring range listed is a good faith determination of potential compensation at the time of this job advertisement and may be modified in the future. What you will be doing JOB DESCRIPTION Denials Specialist The Denials Specialist will have responsibility for the management, reporting, recovery, and prevention of clinical and technical denials received on Hospital services. JOB RESPONSIBILITIES: The specific responsibilities include, but are not limited to: * Reviews claims in which a denial has been received from the payer * Identifies the root cause of the denial and addresses the denial issue with the appropriate department (i.e., Billing, CDM, Clinical Documentation, Coding, etc.) * Utilizes available resources to effectively research claims and complete steps to submit information necessary to process or appeal claims * Independently manages assigned work * Produces reports on denial inventory as requested * Communicates trends in the claim denial populations to the leadership team * Investigates and ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding claims * Completes and requests adjustments to a claim, as appropriate * Organizes work/ resources to accomplish objectives and meet deadlines * Demonstrates critical thinking * Demonstrates problem-solving skills related to denial analysis * Manages multiple responsibilities with ease and completes tasks as assigned * Demonstrates the willingness and ability to work collaboratively with other key internal and external staff, both clinically and administratively to obtain necessary information to address denial management issues * Participates in all educational activities, and demonstrates personal responsibility for job performance * Assists in the development of training material * Uses supplies and equipment effectively and efficiently * Consistently demonstrates a positive and professional attitude at work * Meets quality and productivity requirements to ensure excellent service is provided to customers * Maintains compliance with established corporate and departmental policies and procedures * Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, customers, and co-workers * Maintain satisfactory attendance and punctuality record as set forth by HSS policies * Responsible for the other relevant work functions, as requested EXPERIENCE AND QUALIFICATIONS: * Bachelor's Degree * Preferred 2-3 years business office experience in a healthcare environment * Expert level Excel experience * Strong working knowledge of Microsoft Office Suite * Ability to multi-task and switch easily between assignments * Excellent phone etiquette and internal/external customer services skills * Payment variance or denials management experience preferred * Demonstrates knowledge of insurance regulations and policies, payment policies/guidelines and the ability to communicate and work with payers to get claims resolved and paid accurately * Demonstrates in-depth knowledge and experience in the following technology solutions: patient accounting, optical imaging and scanning, appropriate use of AI, patient systems and internet- based insurance websites * Exceptional interpersonal and influencing skills; success at cultivating strong relationships with internal stakeholders and creating partnerships throughout the organization. Experience working with executive and medical leadership, especially physicians and their offices. * Resolves issues through innovative problem solving and solution development; capable of gaining commitment to project goals. * Stays current on healthcare industry trends and reform; can identify potential impacts and /or problems that may arise during conversion and translate them into remedial action plans. * Outstanding communication skills: succinct and easy to understand, a good listener, skilled at influencing a variety of people. Capable of developing and implementing educational programs for a diverse audience. * Unquestionable personal integrity. Exudes credibility and professionalism. Very likeable. Quickly builds confidence in others. Team player and understands their role in relationship to others. * A highly committed individual, with the necessary drive and stamina to successfully oversee the denials management process. * SKILLS REQUIRED Experience in Healthcare and Revenue Cycle preferred. Open to recent graduates with the ability to think critically, learn and adapt. Ability to adjust to rapidly changing procedures and protocols. Established knowledge of healthcare and health insurance and familiarity with medical terminology a bonus. Effective written and oral communication skills. Technically savvy in all Microsoft Office products, particularly Excel. Ability to be a great teammate and displays an outgoing and positive attitude toward assignments and colleagues. Ability to preform calculations: addition, subtraction, percentages, understand payer reimbursement expectations and solve for variances. POSITION & UNIT ACCOUNTABILITIES * Ensures compliance of managed care companies with negotiated contracts. * Resolves denials and payor issues. Manages appeal creation and submission both manual and AI created. * Maintains Documentation & Manages Information. Creates and maintains reports on open AR and Insurance Payor issues. * Attendance Maintains satisfactory attendance record. * Maintains punctuality. * Adjusts to changing situations and work assignments. Non-Discrimination Policy Hospital for Special Surgery is committed to providing high quality care and skilled, compassionate, reliable service to our community in a safe and healing environment. Consistent with this commitment, Hospital for Special Surgery provides care, admits, and treats patients and provides all services without regard to age, race, color, creed, ethnicity, religion, national origin, culture, language, physical or mental disability, socioeconomic status, veteran or military status, marital status, sex, sexual orientation, gender identity or expression, or any other basis prohibited by federal, state, or local law or by accreditation standards.