Denials Coordinator, Pain/Spine- Newton
Newton-Wellesley Hospital(NWH)

Job Info

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About Us

Newton-Wellesley Hospital is a comprehensive medical center located in Newton. We provide the services and expertise of a major medical facility with the convenience and personal attention of a community hospital. Our team is committed to delivering high-quality, safe, efficient medical care to each of our patients.

We are a proud member of Mass General Brigham, a network founded by Massachusetts General Hospital and Brigham and Women's Hospital. Our affiliation allows us to provide our patients with access to the best community-based medicine and the most advanced specialty care in the world.

Our continued goal at Newton-Wellesley Medical Group is to meet our patients' (and their families'!) health care needs and build long-term relationships that provides them with exceptional care and service.

Our Teams

The vision for this role is to support both the Pain and Spine specialties within Newton-Wellesley Hospital Ambulatory Care Center (159 Wells Avenue in Newton).

• At the Newton-Wellesley Hospital Spine Center we work as a multidisciplinary team, with an emphasis on communication and coordination. Our specialists treat the full range of spinal disorders that affect the cervical, thoracic, and lumbar areas of the spine. After a careful evaluation with diagnostic and imaging tests, we create a personalized treatment plan based on your needs and goals.
• At the Pain Management Service at Newton-Wellesley Hospital, we care for people with many types of pain caused by a number of conditions, including acute pain that comes on suddenly and is caused by a specific injury or condition, chronic pain and cancer-related pain. We use a compassionate, team-based approach to diagnosing, relieving, and treating acute and chronic pain. We tailor our multimodal and multidisciplinary treatment plans to your unique condition and needs. Our top priority is to reduce or eliminate pain and help patients function as independently as possible.

Did we mention that parking is free at this location?

Schedule

We are seeking a full-time, 40-hour Denials Coordinator to support the Pain and Spine teams onsite Monday through Friday from 8:00am to 5:00pm (shifts are staggered). This role has the potential for a future Hybrid day!

Role Overview

The Denials Coordinator researches, analyzes, and resolves claim denials for the hospital. The Denials Coordinator collaborates with insurance companies, central billing, case management, coding and physician offices when necessary to verify claim information, level of care, accurate coding, and payer requirements to ensure financial reimbursement for services.

This is an exciting opportunity to work autonomously but in a setting that is alongside a team of 5 department coordinators!

Responsibilities Include:

• Perform all insurance verification for eligibility, coverage, and authorization requirements via Web or phone with third party payers to obtain retroactive authorization for payment.
• Contacts central billing, physician offices, and insurance companies to validate data, collect missing information and resolve information discrepancies. Understands clinical guidelines for payors requiring authorization to build cases for retro authorization requests and claim denials appeals.
• Work collaboratively with PHS Central Billing Office (CBO) to research, analyze and resolve claim denials
• Identifies, monitors and presents monthly denial performance accompanied with case studies and recommendations for process improvements
• Participates in external payer meetings, presenting payer performance related to denials
• Scheduling and rescheduling patients appointments due to insurance denials

Qualifications
Qualifications

We are looking for well-rounded customer service professional who can multi-task, prioritize, and thrive in a high-volume outpatient setting!

• Must be a high school graduate. Additional college or business experience preferred.
• 1-2 years of insurance, third party payor or secretarial experience in a health care setting required

EEO Statement
Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. 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. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

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