Denials Specialist

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Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Reviews clinical authorization denials and determines appropriate actions per payor to overturn the denial. Functions as a hospital liaison with external third-party payors to review authorization denials.

Job Duties

• Monitors and completes claims on team appeals, reconsiderations, and claim investigations.
• Works with the precertification department and other physician offices on authorization denials.
• Prepares spreadsheets to identify issues, patterns, and trends to share and discuss during meetings.
• Develops and monitors payors' responses to identify appeal deadlines within the appropriate timeframe.
• Pursues retro authorization with the appropriate authorization vendor per payor allowance.
• Writes, handles, and submits all administrative appeals with substantiating documentation within deadline restrictions.

• High School Diploma/GED
• 2 years professional or facility billing and/or collections for all major third party payers or work experience in healthcare related field. and
• Ability to focus on details and coordinate multiple projects simultaneously.
• Ability to read and understand basic medical record documentation.
• Capable of interacting effectively with insurance carriers.

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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