Denial Management Specialist

As a Denial Management Specialist at the University of Maryland Medical System (UMMS), your key responsibilities include managing the receipt and investigation of medical necessity audits and denials. You will review referrals for their appropriateness, create denial tracking records, research denial reasons, liaise with vendors and insurance companies, and prepare appeal packets to ensure timely and accurate processing of claims.

To apply for the Denial Management Specialist role at UMMS, you need at least a High School Diploma or equivalent. Two years of relevant experience in denials/appeals processing, utilization review, or similar fields is required, while an Associate's Degree and three to five years of experience in the same areas provide preferred qualifications.

In the Denial Management Specialist role at UMMS, collaboration with clinical teams is paramount. You will be responsible for assigning denials appropriately, maintaining ongoing communication with clinical staff, and assisting in the triaging and prioritizing of appeals to support the efforts of clinical teams in overturning denials and recovering revenue.

A successful Denial Management Specialist at the University of Maryland Medical System must possess excellent analytical skills to investigate denials thoroughly, strong communication skills for liaising with various stakeholders, and effective organizational skills to manage multiple appeal processes simultaneously. Attention to detail is critical for tracking and documenting denial information accurately.

The work environment for a Denial Management Specialist at UMMS is a hybrid setup, allowing for remote work with occasional in-office presence in Hunt Valley, MD. You'll be part of a supportive and collaborative team that champions high-quality healthcare delivery while valuing innovation and professional growth.

When discussing your experience, highlight specific situations where you successfully managed a denial or appeal process. Use real-life examples that illustrate your problem-solving skills and collaboration with clinical staff or insurance companies, showing your ability to navigate complex situations effectively.

To answer this question, describe your organizational strategies, such as creating action lists or using a tracking system. Emphasize your ability to assess urgency based on factors like potential revenue and deadlines, and convey how you manage time effectively to ensure timely responses.

In your response, detail a specific case where you encountered difficulties. Explain the steps you took to gather information and coordinate efforts with your team and external partners, ultimately showing the outcome and what you learned from that experience.

Mention the resources you use to stay updated, such as industry newsletters, professional organizations, and training opportunities. Emphasize your proactive approach to seeking education, and how adjustments to regulations might influence your denial management strategies.

Provide examples of electronic health record systems or denial management software you’ve utilized. Discuss how these tools helped you in tracking, reporting, and appealing denials, demonstrating familiarity with tech and processes that enhance efficiency.

When answering, highlight your communication strategies, such as being clear, concise, and professional. Discuss how you depend on maintaining relationships to resolve issues and positively impact claims processing, reflecting your diplomatic skills in difficult situations.

Explain your methods for ensuring accuracy, such as double-checking records, using checklists, or peer reviews. Emphasize your attention to detail and commitment to high-quality submissions that enhance the likelihood of successful appeals.

Share specific techniques you use to manage stress, such as prioritizing tasks, taking short breaks, or utilizing time management tactics. Illustrate your ability to maintain productivity under pressure while ensuring quality outcomes.

Discuss your analytical approach to reviewing processes for inefficiencies, tracking metrics, and soliciting feedback from colleagues. Emphasize how addressing these areas can lead to improved workflows and enhanced claim resolutions.

When answering, bridge your personal values and professional goals with UMMS's mission. Explain your motivation for serving the healthcare community and how you aspire to contribute to improved revenue recovery and patient care within the esteemed UMMS network.