The Impact You Can Make The Denial Management Specialist is responsible for tracking, trending and appealing denials associated with the Oncology Service Line across all locations. The Glens Falls Hospital Impact * *Mission Our Mission is to improve the health of people in our region by providing access to exceptional, affordable, and patient-centered care every day and in every setting. How You Will Fulfill Your Potential * * Responsibilities * Appeals denials received by compiling required clinical documentation, letters of medical necessity or information requested by insurers to facilitate payment. * Works in collaboration with ordering providers to obtain additional clinical information to support appeal as necessary. Obtains retro-authorizations when denial is for lack of prior authorization, when allowed by payor. Works collaboratively with Finance to identify reason for denials. * Conducts further investigation to determine root cause of denial (lack of authorization, exceeded allowable units, doesn’t meet medical necessity). * Provides documentation to Finance Team to support denied charges when appropriate ie. evidence of authorization, documentation that authorization was not required etc Education & Experience * High School Diploma or equivalent required * Associates Degree or four (4) years of insurance experience in a healthcare environment preferred * Subject matter expert in prior authorizations for hospital-based services including imaging, buy and bill drugs and treatment related procedures preferred * Proficiency in Medical Terminology required * Knowledge base related to CPT and ICD-10 codes required * Oncology related experience preferred Licenses, Certifications, Registrations * Medical Coding Certification preferred Skills and Abilities * Ability to type 60 WPM * Knowledge of CPT and ICD coding desired; Knowledge of Medicare and third party payer regulations desired * Ability to multitask and meet deadlines * Ability to problem solve and work independently * Strong organizational skills, effective interpersonal skills * *Communities We Serve Located in the foothills of the beautiful Adirondack mountains, Glens Falls is conveniently located a short drive away from the capital region and Lake George. Work at the top of your profession and jumpstart your next career here at Glens Falls Hospital! All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. * *Salary Range The expected base rate for this Glens Falls, New York, United States-based position is $23.13 to $34.69 per hour. Exact rate is determined on a case-by-case basis commensurate with experience level, as well as education and certifications pertaining to each position which may be above the listed job requirements. * * Benefits Glens Falls Hospital is committed to providing our people with valuable and competitive benefits offerings, as it is a core part of providing a strong overall employee experience. A summary of these offerings, which are available to active, full-time and part-time employees who work at least 30 hours per week, can be found here. Job: Administrative/Clerical* *Title: *Lead Referral, Authorization and Denial Management Specialist Location: NY-Glens Falls Requisition ID: 240IV