Business Office Associate-Denial and Appeals

NYU Langone Health is a world-class, patient-centered, integrated academic medical center, known for its excellence in clinical care, research, and education. It comprises more than 200 locations throughout the New York area, including five inpatient locations, a children's hospital, three emergency rooms and a level 1 trauma center. Also part of NYU Langone Health is the Laura and Isaac Perlmutter Cancer Center, a National Cancer Institute designated comprehensive cancer center, and NYU Grossman School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. At NYU Langone Health, equity, diversity, and inclusion are fundamental values. We strive to be a place where our exceptionally talented faculty, staff, and students of all identities can thrive. We embrace diversity, inclusion, and individual skills, ideas, and knowledge. For more information, go tonyulangone.org, and interact with us onLinkedIn,Glassdoor,Indeed,Facebook,Twitter,YouTubeandInstagram.

Position Summary:
We have an exciting opportunity to join our team as a Business Office Associate-Denial and Appeals.

In this role, the successful candidate as the Clinical Appeals Coordinator assists in planning, supporting and managing the administrative operations of the appeal process. In the fulfillment of her duties she/he utilizes a personal computer, fax and scanner and demonstrates competence in the application programs including, not limited to, Microsoft Word, Microsoft Excel, Softmed, FMS, Sorian and EDM. Responsible for Medicare and Medicaid enrollment applications and revalidation for the Hospital, Psychiatric, Dialysis, Homecare and Hospice and Managed Care Contracting.

Job Responsibilities:

Correspondence:

1. Prepare appeals to be mailed to insurance carriers.
2. Scan all appeals/no appeals paperwork, insurance documents and certified signed receipts into the imagining system in a timely manner. Ensures compliant with timeframes for appeals.
3. Interact with Case Management, Finance and HIM to gather necessary data to assist in formulating an insurance appeal.
4. Maintain appropriate filing of all paper copies of appeals, insurance correspondence and certified receipts.

Appeals Process:

1. Maintain accuracy of information of all data for the

purpose of appropriate claims authorization and payment,

for report generation and quality control.

1. Tracks outcome of appeals, validates and quantifies the appeal recoveries.

1. Track the appeal process and monitor turnaround time

for payment.

1. Verify accuracy of payments.

1. Log the appeal or no appeal documents into Softmed.

1. Assist Clinical Appeals Manager in providing updates,

research and correcting billing discrepancies as they arise

and perform various follow-up, as needed.

1. Prepare quarterly summary reports of BMHMC denial episodes.

1. Provide departmental support, as needed.

1. Responsible for Medicare and Medicaid enrollment applications,

as well as, revalidation for the Hospital, Psychiatric, Dialysis, Homecare

and Hospice.

Managed Care Contracting Operations is responsible for implementing managed care contracting strategy. Actively evaluate, negotiate and manage contractual relationships with health plans, and other Payors. Represent Prime the Hospital in the development of long term relationships with Health Plans and other provider entities. Travel as required to negotiate Agreements.

• Ability to review contract language for financial, legal and operational impact and to ensure compliance with State and Federal Regulatory Agencies. Has the ability to develop contract language.
• Analytical skills with emphasis on contract development, assessment and negotiation, financial analysis, problem solving and project/time management essential.
• knowledge of
  • The contracting process from preparation, negotiation and finalization;
  • Contract language development and,
  • Identification of key points requiring mediation.

Minimum Qualifications:
To qualify you must have a minimum high school diploma or equivalent. Associates degree preferred. 3-5 years progressive responsible healthcare work experience required. Administrative/clinical appeals experience preferred.
Accurate and timely updating of member and provider inquiries.
Careful attention to detail, completing work in timely and effective manner in a high volume environment.
Ability to organize and manage workload to meet departmental requirements.
Confidentiality of all medical related information in accordance with established protocols.
Effective oral and verbal communication.
Ability to concentrate and pay close attention to detail.
Proficient in Microsoft Office applications; FMS, patient billing, and Softmed Care Manager a plus.
Occasionally lifts/carries up to 25 lbs.
Occasionally pushes/pulls up to 25 lbs.
Occasionally bends, squats, kneels, and reaches above shoulders.
Sits or stands for long periods of time; 30 minutes or more.

Qualified candidates must be able to effectively communicate with all levels of the organization.

NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.

NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online.
If you wish to view NYU Langone Health's EEO policies, please click here. Please click here to view the Federal "EEO is the law" poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information.

NYU Langone Health provides a salary range to comply with the New York state Law on Salary Transparency in Job Advertisements. The salary range for the role is $41,977.18 - $57,000.00 Annually. Actual salaries depend on a variety of factors, including experience, specialty, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

To view the Pay Transparency Notice, please click here