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About the Role
HSS is a leading hospital for orthopedics and rheumatology, recognized by U.S. News & World Report and a recipient of the Magnet Award for Nursing Excellence. We offer an innovative, supportive, and inclusive environment for professionals at all career stages.
Responsibilities
- Resolve payor issues by reviewing unpaid or pending insurance claims.
- Contact insurance carriers regarding claim status, missing information, and reimbursement issues.
- Research payer responses and follow departmental workflows to facilitate timely reimbursement.
- Escalate complex reimbursement issues requiring additional review.
- Support claim resolution by reviewing denial information and identifying next steps.
- Assist with corrected claims, reconsiderations, appeals, and supporting documentation.
- Coordinate with internal departments to obtain information needed for claim resolution.
- Maintain complete, accurate, and timely account documentation, including payer communications and account activity.
- Update claim history to support continued account resolution.
- Communicate with Coding, HIM, Patient Access, Billing, Cash Posting, and other departments regarding claim issues.
- Route accounts requiring additional review with supporting documentation.
- Monitor routed accounts and follow up as appropriate.
- Escalate unresolved issues when departmental turnaround times are exceeded.
- Achieve established productivity, quality, aging, and inventory management benchmarks.
- Maintain assigned inventory in accordance with departmental service level expectations.
- Support departmental accounts receivable reduction and cash collection goals.
- Participate in departmental process improvement initiatives.
- Ensure follow-up activities comply with payer regulations, hospital policies, and departmental procedures.
- Protect confidential patient and financial information in accordance with HIPAA requirements.
- Maintain current knowledge of payer policies, Epic workflow updates, and departmental procedures.
- Participate in departmental meetings, huddles, training sessions, and quality reviews.
- Communicate effectively with peers and internal departments.
- Demonstrate flexibility with changing work assignments and departmental priorities.
- Maintain satisfactory attendance and punctuality.
Requirements
- Resolves Payor Issues
- Supports Claim Resolution
- Maintains Documentation & Account Information
- Coordinates Interdepartmental Communication
- Productivity & Operational Performance
- Compliance
- Team Collaboration
Skills
- Claim status
- Missing information
- Reimbursement issues
- Payer responses
- Departmental workflows
- Denial information
- Corrected claims
- Reconsiderations
- Appeals
- Supporting documentation
- Account documentation
- Payer communications
- Account activity
- Claim history
- Departmental standards
- Coding
- HIM
- Patient Access
- Billing
- Cash Posting
- Productivity
- Quality
- Aging
- Inventory management
- Accounts receivable reduction
- Cash collection
- Process improvement
- Payer regulations
- Hospital policies
- Departmental procedures
- HIPAA requirements
- Payer policies
- Epic workflow
- Departmental meetings
- Huddles
- Training sessions
- Quality reviews
- Effective communication
- Flexibility
- Attendance
- Punctuality
Work Type
- Regular Full time
Salary/Compensations
- $37.36 - $37.36
Benefits
- Eligible for additional benefits consistent with the role.
About the Company
- 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.
- HSS offers 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.
Equal Opportunity
- 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.
- 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.